AB0523 Splenectomy in Systemic Lupus Erythematosus Versus Autoimmune Hematological Diseases: To Late or to Early?

BackgroundAcute presentation of severe autoimmune thrombocytopenia (AT) and hemolytic anemia (AHA) in systemic lupus erythematosus (SLE) is associated with high mortality. Splenectomy is the second line of treatmentObjectivesInvestigate the efficacy and safety of splenectomy in SLE patients compared with patients without SLE presenting acute, severe, refractory, life threatening AT and AHA.MethodsFrom January 2004 to April 2014, 34 patients underwent splenectomy. The patients were divided into two groups. Group 1, 18 patients with AT-SLE/APSA. Group 2: 16 patients without SLE: AT/AHA. Demographic and clinical data were analyze. Refractory hematological manifestations were defined according to Mayo Clinic Criteria as: 1. If patients did not maintain platelets ≥50,000 per ml for 2 weeks on medical therapy; 2. Medically dependent. 3. Medically intolerant. Patients with hemolytic anemia were submitted to surgery when they developed 2 hemolytic crisis (fever, jaudice, pallor, abdominal pain, and haemoglobin ≤6 gr/dL) despite to conventional treatment over a period of 6 months. After splenectomy, the response were considered for thrombocytopenia as follows: 1. Complete response: ≥150,000 platelets per ml, 2. Partial response: 50,000 to 149,000 per ml or 3. No response: