Outcome of splenectomy for thrombocytopenia associated with systemic lupus erythematosus

Ann Surg. 2004 Aug;240(2):286-92. doi: 10.1097/01.sla.0000133182.92780.9c.


Objective: To determine the efficacy of splenectomy for treating thrombocytopenia associated with systemic lupus erythematosus (SLE).

Summary background data: The role of splenectomy has been controversial in this patient population.

Methods: Between 1975 and 2001, 25 consecutive adults with SLE underwent splenectomy specifically for thrombocytopenia. Surgical indications, operative mortality and morbidity, and hematological outcomes were followed in both the short-term (first 30 days) and the long-term (last recorded platelet count, last contact, or death). Response to splenectomy was rated as: complete (CR: platelets >/=150 x 10/L for at least 4 weeks), partial (PR: platelets 50-149 x 10/L for at least 4 weeks), or none (NR: platelets < 50 x 10/L at all times). Relapse occurred if platelets fell below 50 x 10/L after CR or PR.

Results: Indications for splenectomy included: thrombocytopenia refractory to (64%), dependent on (20%), or patient intolerance of (16%) medical treatments. Perioperative mortality was 0% and morbidity was 24%. After a median of 9.5 years, 9 patients (36%) had died, with only 1 death being secondary to bleeding. Early partial or complete response rate to splenectomy was 88%. After a median follow-up of 6.6 years, 16 (64%) patients had sustained complete or partial response without relapse. Eight (32%) of these patients required adjunctive medical therapy, whereas the other 8 (32%) did not. The remaining 9 (36%) patients relapsed, but 5 (20%) of the 9 patients were subsequently salvaged to at least partial response with further treatments. The overall PR or CR to splenectomy combined with medical therapy was 84%.

Conclusion: Splenectomy should be considered safe and efficacious for thrombocytopenia associated with SLE.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Infant, Newborn
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / diagnosis
  • Lupus Erythematosus, Systemic / mortality
  • Male
  • Middle Aged
  • Probability
  • Recurrence
  • Registries
  • Risk Assessment
  • Severity of Illness Index
  • Splenectomy / methods*
  • Survival Analysis
  • Thrombocytopenia / complications*
  • Thrombocytopenia / diagnosis
  • Thrombocytopenia / mortality
  • Thrombocytopenia / surgery*
  • Treatment Outcome