Document Detail


Comparative response to splenectomy in Coombs-positive autoimmune hemolytic anemia with or without associated disease.
MedLine Citation:
PMID:  10367787     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We reviewed our experience in 30 patients with direct Coombs-positive (DAT+) autoimmune hemolytic anemia (AHA) who underwent splenectomy. Twelve patients had idiopathic "warm" AHA (group I) and 18 had AHA associated with systemic diseases (group II). Complete response to splenectomy was defined as having normal hemoglobin and reticulocyte count lasting for at least 6 months without subsequent medical therapy. Subnormal but greater than 50% improvement in these parameters with or without medical therapy was considered to be a partial response. Median age was 64 (23-81) in group I and 68 (23-76) in group II. Median follow-up duration was 18 and 10.9 months, respectively. Nine of 11 (82%) evaluable patients with idiopathic AHA and 3 of 16 (19%) patients with associated disease achieved a complete response. Partial response was obtained in 2 (18%) and 6 (37%) patients in groups I and II, respectively. Both complete-response and overall-response rates were statistically different between two groups (P = 0.001 and 0.02). Postoperative courses of group I patients were uneventful except for one who developed a subphrenic abscess. Five patients in group II developed bacterial infections, which were mostly pneumonias. Our findings indicate that splenectomy is an effective treatment approach with low morbidity and mortality in patients with refractory idiopathic AHA. It should, however, be considered cautiously in AHA patients with underlying systemic diseases because of its decreased efficacy and increased surgical morbidity in this subgroup.
Authors:
G Akpek; D McAneny; L Weintraub
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of hematology     Volume:  61     ISSN:  0361-8609     ISO Abbreviation:  Am. J. Hematol.     Publication Date:  1999 Jun 
Date Detail:
Created Date:  1999-06-24     Completed Date:  1999-06-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7610369     Medline TA:  Am J Hematol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  98-102     Citation Subset:  IM    
Affiliation:
Section of Hematology/Oncology, Boston University School of Medicine, Massachusetts, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Anemia, Hemolytic, Autoimmune / complications,  diagnosis*,  epidemiology,  surgery*
Coombs' Test*
Female
Humans
Male
Middle Aged
Morbidity
Mortality
Postoperative Complications
Postoperative Period
Splenectomy*
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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