Hypersplenism is the state where the spleen is stimulated over consume blood cells (white blood cells, red blood cells, platelets) resulting in problems with anemia or decreased white blood cell counts or decreased platelet counts. ITP is probably the most common form of hypersplenism where surgery improves. Other conditions can result in increased or destruction of red blood cells resulting in profound anemia (hereditary spherocytosis, autoimmune hemolytic anemia, hereditary elliptocytosis, thalassemia). Sometimes blood cancer can cause hypersplenism such as in hairy cell leukemia, chronic lymphocytic leukemia, chronic myelogenous leukemia, and even in cases of non-Hodgkin’s.

Idiopathic thrombocytopenic purpura (ITP) is a disorder of the body where the immune system develops antibodies to blood cells. As a result the immune system attacks the blood cells and induces increased destruction of blood cells resulting in problems such as anemia or decreased white cell count or especially in platelet count. With ITP the affect seems to be greatest on the platelets such that the platelets become “coated” with antibodies. The spleen and other areas of the body incorrectly see the platelets as damaged and destroy them resulting in an over consumption of platelets resulting in the platelet count falling dramatically. With an extremely low platelet count the body’s ability to clot is hampered and people can develop problems with bleeding and bruising that can be damaging to health and even threaten their life if unchecked. Most such patients are diagnosed and helped manage by a hematologist who specializes in blood disorders.

Initial treatment involves trying to turn the immune system off from attacking the blood cells and this usually involves immune modulating medicines such as steroids or immunosuppressants. Sometimes these work but unfortunately the body often cannot adequately suppressed by these medications and destruction of the platelets continues. As a result persistent bleeding problems can result.

Another option that can help is to actually remove the organ that does most of the consumption, i.e. the spleen. By removing the spleen the platelets destruction does not happen as often and platelet counts can rise back to a more normal safe level. Unfortunately in the majority of cases while steroids often provide a good response in over 75% of the patients only a minority of patients have that improvement sustained. They need a second line of medical treatment. Often this involves administration of immunoglobins to help block and turn off the immune production. Unfortunately this often results in a short term result. A more definitive therapy is removal of the spleen. By removing the spleen there is about a 60-90% chance of complete remission of the effects of ITP with normal function of platelet count levels and the majority of people who do not have a good long-term response at least have a marked improvement making their ITP much easier to manage.

The spleen can often be removed laparoscopically through tiny incisions. The surgery itself involves general anesthesia where the patient is completely asleep. The patient is turned on his right side down with his left side up while positioned carefully to avoid any nerve or muscle pinching. Four to five tiny incisions are typically used and the blood supply to and from the spleen is freed off from its connections to the colon, the stomach, as well as to the aorta and inferior vena cava. The surgery itself usually takes a couple of hours. In most cases the spleen can be removed this way unless it is profoundly enlarged or adherent. Because there is usually not an issue of cancer within the spleen, the spleen can be broken up and fractured into tiny pieces and removed out through a tiny incision thereby avoiding a large incision involving the whole left half of the ribcage. Most people stay in the hospital for only a matter of a couple of days and recover rather quickly.

Risks of having the spleen removed include bleeding, need for blood transfusion, and infections. With the removal of the spleen the immune system still functions rather well however patients are at increased risk of having problems with infections with certain types of organisms and therefore recommendation of having vaccination against these organisms (haemophilus influenza vaccine, streptococcus vaccine, meningococcus vaccine) is recommended to minimize those risks. Those risks are more common in children rather than adults. Fortunately the incidence of severe life threatening infections after removal of the spleen is relatively rare.

The surgeons at Regional Surgical Specialists have advanced laparoscopic techniques to be able to perform splenectomy in a safe and efficient manner. If you have any questions or concerns please contact us at 828-252-3366.

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