Question 5#

Splenectomy is indicated as a treatment in which of the following conditions?

A. Cold-antibody autoimmune hemolytic anemia (AIHA)
B. Hodgkin's disease
C. G6PD deficiency
D. Abscesses of the spleen

Correct Answer is D


Autoimmune hemolytic anemias (AIHA) are characterized by destruction ofRBCs due to autoantibodies against RBC antigens. AIHA is divided into warm and cold categories based on the temperature at which the autoantibodies exert their effect. In cold-agglutinin disease severe symptoms are uncommon and splenectomy is almost never indicated. Warm-agglutinin disease presents with mild jaundice as well as symptoms and signs of anemia with one-third to one-half of patients presenting with splenomegaly. Initial treatment is with corticosteroids with splenectomy being second-line therapy with failure of steroids. Although splenectomy has a 60 to 80% response rate recurrence is common. Hodgkin's disease is a disorder of the lymphoid system characterized by the presence of ReedSternberg cells. Most patients present with lympadenopathy above the diaphragm with adenopathy below the diaphragm rare on presentation. Adenopathy below the diaphragm can arise with disease progression and the spleen is often an occult site of spread although splenomegaly is uncommon. While splenectomy is performed for surgical staging in certain cases including clinical suspicion of lymphoma without evidence of peripheral disease or restaging for suspicion of failure after chemotherapy, staging laparotomy is less commonly performed in the current era of minimally invasive surgery and advanced imaging techniques. G6PD deficiency is the most common RBC enzyme deficiency and can be characterized by chronic hemolytic anemia, acute intermittent hemolytic episodes, or no hemolysis depending on the variant. Treatment for G6PD deficiency involves avoidance of drugs known to precipitate hemolysis. Treatment for splenic abscess involves initiation ofbroad-spectrum antibiotics with tailoring of antibiotic therapy once culture results become available as well as splenectomy. While splenectomy is the procedure of choice percutaneous or open drainage are options for patients unable to tolerate splenectomy.