Patients with autoimmune hemolytic anemia (AIHA) who undergo splenectomy may be at a greatly increased risk for morbidity, including venous thromboembolism (VTE), abdominal thromboembolism (abVTE), and sepsis, according to research published in Blood Cells, Molecules, and Diseases.

AIHA, which has heterogenous clinical outcomes, often presents as an acute disease, but may become chronic. High-dose steroids lead to a good response in 80% of patients with AIHA, but some may become steroid-dependent or steroid-refractory. In these cases, patients may undergo splenectomy, but this procedure yields mixed responses.

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Furthermore, hemolytic anemia is associated with VTE and abVTE, though it is currently unclear whether this is true for all patients with the disease or only for those who undergo splenectomy. In this study, researchers analyzed data from 4756 patients with AIHA to determine whether splenectomy raises the risk for VTE, abVTE, or sepsis in this patient group.

In total, 504 (10.6%) patients underwent splenectomy. The majority (58.9%) of all patients were female, 58.4% were non-Hispanic white, and 46.1% had 1 or 2 comorbidities at baseline. Hispanic patients, patients diagnosed prior to 2005, and younger patients were all more likely to undergo splenectomy.


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Patients who underwent splenectomy were more likely to experience VTE (11.7% vs 4.7%; P <.0001), abVTE (3.8% vs 1.0%; P <.0001), and sepsis (28.0% vs 18.6%; P <.0001). However, splenectomy was also associated with lower risk for all-cause mortality (35.5% vs 42.8%; P =.0018).

Splenectomy was associated with higher risk for VTE in both the immediate (hazard ratio [HR], 2.66) and late postoperative periods (HR, 3.29) as well as greatly increased risk for abVTE in the immediate postoperative period (HR, 34.11). Sepsis, however, occurred at a higher rate only in the late postoperative period (HR, 2.2).

VTE, abVTE, and sepsis were all linked to higher mortality risk, as were older age and having more than 1 comorbidity.

“We observed a significant increased risk for both immediate and late postoperative VTE events and long-term risk for sepsis in patients with AIHA who underwent splenectomy,” the researchers concluded. “Given this high cumulative incidence of VTE in splenectomized patients, prophylactic anticoagulation may be justified and should be further evaluated in prospective studies.”

Reference

1.     Ho G, Brunson A, Keegan THM, Wun T. Splenectomy and the incidence of venous thromboembolism and sepsis in patients with autoimmune hemolytic anemia [published online November 28, 2019]. Blood Cells Mol Dis. doi:10.1016/j.bcmd.2019.102388