Clinical Rheumatology

, Volume 37, Issue 4, pp 943–948 | Cite as

Splenectomy in systemic lupus erythematosus and autoimmune hematologic disease: a comparative analysis

  • Nahim Barron
  • Jesús Arenas-Osuna
  • Gabriela Medina
  • María Pilar Cruz-Dominguez
  • Fernando González-Romero
  • José Arturo Velásques-García
  • Ernesto Alonso Ayala-López
  • Luis J. Jara
Original Article


The objective of the study is to analyze the efficacy and safety of splenectomy in the management of refractory autoimmune thrombocytopenia (AT)/autoimmune hemolytic anemia (AIHA) associated or not with systemic lupus erythematosus. Thirty-four patients after splenectomy due to severe AT and/or AIHA were divided into group 1 (G1) 18 SLE/APS patients: 9 AT/SLE patients, 6 SLE/antiphospholipid syndrome (APS), and 3 primary APS. Group 2 (G2): 16 patients without SLE/APS: 2 Fisher-Evans syndrome and 14 AIHA. Surgery approach when (1) platelets ≤ 50,000/ml despite 2 weeks on medical therapy, (2) medically dependent, and (3) medically intolerant or after two hemolytic crises in AIHA patients. Splenectomy response: (1) complete (CR): ≥ 150,000 platelets/ml, (2) partial: 50,000–149,000/ml, or (3) none: ≤ 50,000/ml. CR for AIHA: hemoglobin ≥9 g/dl. Statistical analysis: descriptive statistics and chi-square test. The mean age was 34.6 years; mean follow-up: 28.5 months. Open splenectomy in 15/34 vs laparoscopy in 19/34 (p = NS). CR in 15/34, G1: 4/18, G2: 11/16, (p = 0.006). Complications in 6/34, 5 from G2 vs 1 from G1 (p = 0.05). Relapse in 7/18 patients in G1 and 3/16 in G2 (p = 0.05). Open and laparoscopic splenectomies in SLE and AT patients are as effective as in those without SLE; however, patients with SLE and APS had more relapses.


Antiphospholipid syndrome Hemolytic anemia Splenectomy Systemic lupus erythematosus Thrombocytopenia 



The authors thank to Dr. Bernal Humberto Esquinca Moreno for the kind supply of the spleen photograph.

Compliance with ethical standards




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Nahim Barron
    • 1
  • Jesús Arenas-Osuna
    • 2
  • Gabriela Medina
    • 3
  • María Pilar Cruz-Dominguez
    • 4
  • Fernando González-Romero
    • 1
  • José Arturo Velásques-García
    • 1
  • Ernesto Alonso Ayala-López
    • 5
  • Luis J. Jara
    • 6
  1. 1.Surgery Department, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico
  2. 2.Education Division, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico
  3. 3.Clinical Research Unit, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico
  4. 4.Research Division, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico
  5. 5.General Direction, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico
  6. 6.Direction of Education and Research, Hospital de Especialidades Centro Médico La RazaInstituto Mexicano del Seguro Social (IMSS)Mexico CityMexico

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