Indications for splenectomy:
(1) hypersplenism with severe anemia and/or thrombocytopenia, especially when:
(1a) the patient is refractory to chemotherapy
(1b) the patient is unable to undergo adequate chemotherapy due to severe cytopenias
(1c) there is concern that radiation may worsen the cytopenia
(1d) the patient is refractory to radiation therapy
(2) massive splenomegaly unresponsive to chemotherapy
(3) severe autoimmune anemia or thrombocytopenia unresponsive to medical management
Criteria for a positive response to splenectomy (Neal et al, 1992):
(1) hemoglobin >= 11 g/dL 3 months after surgery with a presplenectomy value < 11 g/dL
(2) platelet count >= 100,000 per µL 3 months after surgery with a presplenectomy platelet count < 100,000 per µL
Additional concerns:
(1) Perioperative morbidity may occur in up to 29% while mortality may range from 2-9%, so informed consent is important.
(2) The patient will be at increased risk for opportunistic infections. Pneumococcal vaccine should be administered before the splenectomy with supplemental injections as needed.
(3) Removal of the spleen may not correct the severe cytopenia. Patients who are nonresponders to the procedure tend to have a poor prognosis.
(4) Removal of the spleen does not increase overall survival but may reduce dependency on transfusion and can improve the patient's sense of physical well-being.
