1
|
Singer KE, Bercz AP, Morris MC, Elson NC, Wallen TE, Hanseman D, Pritts TA, Nomellini V, Patel SH, Makley AT, Goodman MD. Acute and chronic hematologic implications of emergency and elective splenectomy. J Surg Res 2021; 267:197-202. [PMID: 34153562 DOI: 10.1016/j.jss.2021.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/11/2021] [Accepted: 05/07/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Thrombocytosis and leukocytosis are common after splenectomy. The potential effect of emergency surgery on these postoperative findings is unknown. We hypothesized that emergency splenectomy leads to a more profound and persistent hematologic change as compared to elective splenectomy. METHODS A retrospective review was conducted of patients who underwent elective or trauma splenectomy. Records were queried for platelet (PLT) and white blood cell (WBC) count prior to splenectomy, on postoperative days 1-5, and at day 14, 1 month, 3 months, 6 months, and 1 year. Complications, including thromboembolic events, infection, need for repeat operation, and readmission within 30 days of discharge, were recorded. RESULTS 463 patients were identified as being eligible for the study, with 173 patients in the elective cohort and 145 patients in each of the isolated trauma splenectomy and polytrauma cohorts. Both cohorts had peak thrombocytosis at week 2 postoperatively. However, polytrauma patients had a significantly higher peak platelet count (P < 0.01). The PLT:WBC ratio was lower in both trauma cohorts pre-operatively and postoperative day 1. Trauma splenectomy had a higher PLT:WBC ratio on days 2 and 3 whereas polytrauma had a lower ratio on days 4 and 5. Emergency cases had greater reoperation and infection rates, whereas elective cases were more likely to require readmission. Postoperative thromboembolic events were only higher in the polytrauma cohort. CONCLUSIONS While trauma splenectomy resulted in more profound postoperative leukocytosis and thrombocytosis, there was no correlation with timing of infection or risk of thromboembolic events. These findings suggest that thrombocytosis and leukocytosis may be associated with thrombotic and infectious events but their presence alone does not indicate direct risks of concomitant infection or thrombosis.
Collapse
Affiliation(s)
- Kathleen E Singer
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Aron P Bercz
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Mackenzie C Morris
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Nora C Elson
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Taylor E Wallen
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Dennis Hanseman
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Timothy A Pritts
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Vanessa Nomellini
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Sameer H Patel
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Amy T Makley
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati
| | - Michael D Goodman
- University of Cincinnati, Department of Surgery, Section of General Surgery, Cincinnati.
| |
Collapse
|
2
|
Filippova OT, Kim SW, Cowan RA, Chi AJ, Iasonos A, Zhou QC, Broach V, Zivanovic O, Long Roche K, Sonoda Y, Gardner G, Chi DS. Hematologic changes after splenectomy for ovarian cancer debulking surgery, and association with infection and venous thromboembolism. Int J Gynecol Cancer 2020; 30:1183-1188. [PMID: 32665236 DOI: 10.1136/ijgc-2020-001368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The spleen plays a role in the immune and coagulative responses, yet a splenectomy may be required during ovarian cancer surgery to achieve complete cytoreduction. The aim of the study was to correlate hematologic changes with the development of infection and venous thromboembolism in patients undergoing splenectomy. METHODS This single-institution retrospective review includes all patients undergoing splenectomy during cytoreductive surgery for advanced ovarian cancer, March 2001 to December 2016. We compared postoperative hematologic changes (evaluated daily before discharge) in patients developing infection within 30 days' post-surgery (Infection group) with those who did not (No-Infection group). We also compared patients developing venous thromboembolism with those without. RESULTS A total of 265 patients underwent splenectomy. Median age was 64 years (range 22-88): 146 (55%) patients had stage IIIC and 114 (43%) patients had stage IV. The majority, 201 (76%) patients underwent splenectomy during primary debulking. A total of 132 (50%) patients comprised the Infection group (most common: urinary tract infection, 54%). Median time from surgery to infection was 8 days (range, 0-29). After initial rise in white blood cell count in both groups, the Infection group had a second peak on postoperative day 10 (median 16.6K/mcL, IQR 12.5-21.2) not seen in the No-Infection group (median 12K/mcL, IQR 9.3-16.3). A total of 40 (15%) patients developed venous thromboembolism, median time of 6.5 days (range, 1-43). All patients demonstrated a continuous rise in platelets during postoperative days 0-15. Thrombocytosis was present in 38/40 (95%) patients with venous thromboembolism vs 183/225 (81%) patients without (P=0.036). Median days with thrombocytosis was higher in venous thromboembolism (8 days, range 1-15) vs non groups (6 days, range 1-16, P=0.049). CONCLUSION We identified initial leukocytosis after splenectomy in all patients. The Infection group had a second peak in white blood cell count on postoperative day 10, not present in the No-Infection group. Among patients with venous thromboembolism, thrombocytosis was more frequent and of longer duration.
Collapse
Affiliation(s)
- Olga T Filippova
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sun Woo Kim
- University of Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Renee A Cowan
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Alexia Iasonos
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Qin C Zhou
- Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vance Broach
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Oliver Zivanovic
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kara Long Roche
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukio Sonoda
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ginger Gardner
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dennis S Chi
- Gynecologic Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
3
|
Perioperative effects of desflurane versus propofol on hemostasis guided by thromboelastometry in splenectomy with liver cirrhosis. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
4
|
Bilello JF, Sharp VL, Dirks RC, Kaups KL, Davis JW. After the embo: predicting non-hemorrhagic indications for splenectomy after angioembolization in patients with blunt trauma. Trauma Surg Acute Care Open 2018; 3:e000159. [PMID: 29766137 PMCID: PMC5887792 DOI: 10.1136/tsaco-2017-000159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 11/13/2022] Open
Abstract
Background Successful non-operative management (NOM) of blunt splenic trauma is enhanced with splenic angioembolization (SAE). Patients may still require splenectomy post-SAE for splenic infarction/necrosis. Prior studies have used white blood cell count (WBC), platelet count (PLT), and PLT:WBC ratio after splenectomy to predict complications, but none have evaluated these findings prior to splenectomy in patients who have undergone SAE. Changes in these values may indicate clinically significant splenic infarction, facilitating management of these patients. Methods Patients admitted to an American College of Surgeons verified level 1 trauma center from January 2007 to August 2017 who underwent SAE were identified. Patients with successful NOM after SAE (SAE/NOM) were compared with those requiring splenectomy (SAE/SPLEN). Data included demographics, splenic injury grade, Injury Severity Score (ISS), time to SAE and splenectomy, intensive care unit and hospital length of stay (LOS), and complete blood count. Lab values were analyzed immediately post-SAE (time 1) and day 5 post-SAE (or day of discharge) for SAE/NOM patients and day of SPLEN for SAE/SPLEN patients (time 2). Data were analyzed using Mann-Whitney U, χ2 tests, and receiver operating characteristic (ROC) curves with significance attributed to P<0.05. Results Of 124 patients undergoing SAE, 16 (13%) later required SPLEN for infarction/necrosis at a median of 5 days post-SAE (IQR: 3–10 days). SAE/SPLEN and SAE/NOM patients did not differ by age, gender, ISS, or grade of splenic injury. SAE/SPLEN patients had longer hospital LOS (23 vs. 10 days, P<0.001). WBC, PLT, and PLT:WBC ratio did not differ between the groups at time 1. At time 2, WBC was higher and PLT:WBC ratio was lower in SAE/SPLEN patients. Using ROC curves at time 2, the area under the curve was 0.90 (P<0.001) for WBC and 0.71 (P<0.007) for PLT:WBC ratio. Discussion Patients requiring splenectomy for clinically significant infarction/necrosis after SAE develop leukocytosis and decreased PLT:WBC ratio when compared with SAE/NOM patients. Monitoring these parameters allows more prompt diagnosis and operative intervention. Level of evidence Therapeutic/care management, level III.
Collapse
Affiliation(s)
- John F Bilello
- Department of Surgery, Community Regional Medical Center, University of California San Francisco-Fresno, Fresno, California, USA
| | - Victoria L Sharp
- Department of Surgery, Beaumont Hospital, Farmington Hills, Michigan, USA
| | - Rachel C Dirks
- Department of Surgery, Community Regional Medical Center, University of California San Francisco-Fresno, Fresno, California, USA
| | - Krista L Kaups
- Department of Surgery, Community Regional Medical Center, University of California San Francisco-Fresno, Fresno, California, USA
| | - James W Davis
- Department of Surgery, Community Regional Medical Center, University of California San Francisco-Fresno, Fresno, California, USA
| |
Collapse
|
5
|
Rab MAE, Meerveld-Eggink A, van Velzen-Blad H, van Loon D, Rijkers GT, de Weerdt O. Persistent changes in circulating white blood cell populations after splenectomy. Int J Hematol 2017; 107:157-165. [PMID: 28952075 DOI: 10.1007/s12185-017-2335-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
The effect of splenectomy on the incidence of infections and thromboembolisms has been investigated thoroughly. Nevertheless, the long-term effects of splenectomy on immunological profile and circulating blood counts have not been described before. To study such long-term effects, we analysed several parameters in splenectomised trauma patients and compared the results of this group ("otherwise healthy patients") to patients with a specific underlying disease. We measured platelet count, leukocytes and differential, lymphocyte subsets, serum levels of immunoglobulins, and complement pathways in 113 patients. Indications to perform a splenectomy were trauma (n = 42), Hodgkin lymphoma (n = 24), hereditary spherocytosis (n = 21), and immune thrombocytopenia (n = 26). In trauma patients lymphocytes and lymphocytes subsets were particularly elevated compared to normal population values. Splenectomised patients with Hodgkin lymphoma had significant lower numbers of T lymphocytes than trauma patients. Significant increases in platelets, leukocytes, and monocytes were observed in patients with hereditary spherocytosis. Occurrence of MBL genotype was different in ITP patients than in other splenectomised groups and the normal population. In splenectomised patients (> 4 years), platelet counts and lymphocyte subsets are increased which persist over time. As a result, these blood counts in splenectomised patients differ from reference values in the normal population.
Collapse
Affiliation(s)
- Minke A E Rab
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
- Department of Internal Medicine and Dermatology, University Medical Centre Utrecht, Van Creveldkliniek, Heidelberglaan 100, 3508 GA, Utrecht, The Netherlands.
| | | | - Heleen van Velzen-Blad
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Douwe van Loon
- Department of Clinical Chemistry and Haematology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Ger T Rijkers
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Science, University College Roosevelt, Middelburg, The Netherlands
| | - Okke de Weerdt
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| |
Collapse
|
6
|
Jia Y, Wang Y, Yu X. Relationship between blood lactic acid, blood procalcitonin, C-reactive protein and neonatal sepsis and corresponding prognostic significance in sick children. Exp Ther Med 2017; 14:2189-2193. [PMID: 28962140 PMCID: PMC5609195 DOI: 10.3892/etm.2017.4713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 05/22/2017] [Indexed: 01/14/2023] Open
Abstract
The study was conducted to evaluate the relationship between the blood lactic acid (BLA) level, serum procalcitonin (PCT), C-reactive protein (CRP) and the severity and prognosis of neonatal sepsis. A retrospective analysis was conducted on 90 children with sepsis admitted into the Intensive Care Unit (ICU) of the Hubei Institute for Nationalities Af liated Hospital hospital. Patients were divided into the non-survival group and the survival group. Severity of the 90 patients was evaluated according to Neonatal Critical Illness Score (NCIS). Observations were made on changes of the levels of BLA, PCT and CRP, correlation between BLA, PCT, CRP and NCIS as well as the association of the levels of these proteins with the prognosis of the patients. The 90 sick children were divided into the survival group (61 cases, 67.7%) and the non-survival group (29 cases, 32.2%). They were further stratified into the extremely severe group (n=20), severe group (n=39) and non-severe group (n=31) according to NCIS scoring standard. The BLA and NCIS scores of the non-survival group were significantly greater than those of the survival group. The difference was statistically significant (P<0.05). We found that there was a significant negative correlation between the BLA values and NCIS scores of the two groups. We also demonstrated significant positive correlation between the BLA value, PCT and CR (P<0.05). We observed a significant negative correlation between PCT, CRP and NCIS scores (P<0.05). The PCT level of the non-survival group was significantly higher than that of the survival group (P<0.05), while the NCIS score was significantly lower than that of the survival group (P<0.05). The CRP and PCT protein expression results of the sepsis patients were higher than those of the control group. Therefore, there is a significant correlation between BLA, CRP, PCT and NCIS. The lower the NCIS score is, the more significant the increase of BLA, PCT and CRP. Thus, the combined detection of levels of BLA, PCT and CRP may predict the severity of neonatal sepsis patients and their prognosis.
Collapse
Affiliation(s)
- Yongfeng Jia
- Neonatal Department, Shangluo Center Hospital, Shangluo, Shaanxi 721000, P.R. China
| | - Ying Wang
- Pediatric Internal Medicine, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China
| | - Xinhua Yu
- Department of Pediatrics, Hubei Institute for Nationalities Affiliated Hospital, Enshi, Hubei 445000, P.R. China
| |
Collapse
|
7
|
Abstract
Leukocytosis is among the most common findings on peripheral blood smear. A wide range of causes may mediate this finding, and careful clinical and laboratory evaluation assist in differentiating between benign and malignant causes of increased white blood cell counts. In this article, various nonmalignant causes are explored, including infectious, inflammatory, autoimmune, and allergic. In addition, malignant causes of leukocytosis are discussed, including myeloproliferative disorders, acute leukemia, and chronic leukemia, as well as treatment and monitoring for patients with these diseases.
Collapse
Affiliation(s)
- Page Widick
- Department of Internal Medicine, Rhode Island Hospital, Brown University, JB 0100, 593 Eddy Street, Providence, RI 02903, USA
| | - Eric S Winer
- Division of Hematology/Oncology, Rhode Island Hospital, Brown University, 593 Eddy Street, Providence, RI 02903, USA.
| |
Collapse
|