AB0523 Splenectomy in Systemic Lupus Erythematosus Versus Autoimmune Hematological Diseases: To Late or to Early?
Authors: G.N. Barron, J. Arenas-Osuna, A. Velazquez-Garcia, A. Gonzalez-Zúñiga, M.A. Saavedra, P. Cruz-Dominguez, G. Medina, L.J. Jara
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Acute presentation of severe autoimmune thrombocytopenia (AT) and hemolytic anemia (AHA) in systemic lupus erythematosus (SLE) is associated with high mortality. Splenectomy is the second line of treatment <h3>Objectives</h3> Investigate the efficacy and safety of splenectomy in SLE patients compared with patients without SLE presenting acute, severe, refractory, life threatening AT and AHA. <h3>Methods</h3> From January 2004 to April 2014, 34 patients underwent splenectomy. The patients were divided into two groups. Group 1, 18 patients with AT-SLE/APSA. Group 2: 16 patients without SLE: AT/AHA. Demographic and clinical data were analyze. Refractory hematological manifestations were defined according to Mayo Clinic Criteria as: 1. If patients did not maintain platelets ≥50,000 per ml for 2 weeks on medical therapy; 2. Medically dependent. 3. Medically intolerant. Patients with hemolytic anemia were submitted to surgery when they developed 2 hemolytic crisis (fever, jaudice, pallor, abdominal pain, and haemoglobin ≤6 gr/dL) despite to conventional treatment over a period of 6 months. After splenectomy, the response were considered for thrombocytopenia as follows: 1. Complete response: ≥150,000 platelets per ml, 2. Partial response: 50,000 to 149,000 per ml or 3. No response: &lt;50,000 per ml. The complete response for hemolityc anemia as hemoglobin ≥9 gr per dl.The inmediate response were evaluated after 7 days. The mean of follow up were 28.5 months (range 3-96 months). Statistical Analysis: descriptive stadistics, U-Mann-Whitney test and Chi square test. <h3>Results</h3> The mean age of 34 patients (28 female) were 34.6 years old (range 18-62 y.o.). The duration of disease:Group 1 vs Group 2: 58.3±50.6 vs 27.13±27.9 months (p&lt;0.033). The time of AT/AHA diagnosis: Group 1 vs Group 2 (p&lt;0.000). No difference was found in the mean of period between hematologic manifestations and surgery. Open splenectomy was performed in 15/34 patients and laparoscopy in 19/34 patients, 3 converted to open surgery (15.78%). The inmediate complete response were observed in 15/34, (67.64%). For Group1, 4/18 (22.2%) and for Group 2, 11/16, (68.8%) (p=0.006).After 30 days of surgery a complete response were observed in 11/18, (61.1%) for Group 1, and 13/16, (81.2%) for Group 2 (p=NS). The complications in the inmediate post-operative period were observed in 6/34, (17.64%), 1 from Group 1 vs 5 from Group 2 (p=0.05). Infections in 3/34 (8.82%), one patient had bleeding and 2 had mesenteric and portal vein thrombosis respectively. After follow up, in Group 1, the relapse were observed in 7/18 patients (38.9%), and in Group 2, 3/16, (18.75%) (p&lt;0.05). The mortality was zero in both groups of patients <h3>Conclusions</h3> This study suggest:Despite the long duration of disease, patients with SLE/APS have a similar response to splenectomy compared with AT/AHA. Patients with SLE/APS had a significant increase of relapses. The splenectomy is safety and effective in severe and refractory hematologic manifestations. <h3>Disclosure of Interest</h3> None declared