Platelet Kinetics and Decreased Transfusion Requirements After Splenectomy for Hematologic Malignancy

OBJECTIVE: Thrombocytopenia is a significant and morbid problem in patients with hematologic malignancy, resulting in frequent platelet transfusions and significant resource consumption. We undertook this study to determine the impact of splenectomy on transfusion requirements in patients with chronic leukemia, acute leukemia, myelodysplastic syndrome, and lymphoma. METHODS: Records of 134 patients with hematologic malignancies who underwent splenectomy were reviewed. Results are reported as mean ± standard error of the mean. RESULTS: Mean preoperative (preop) platelet count was 97 ± 8 K/μL. A significant rise in platelets, compared with preop, was observed starting on postsplenectomy day 1 (141 ± 8 K/μL, P < 0.001 versus preop) and persisted through day 7. Counts remained significantly elevated at 3 and 6 months and years 1–5. In profoundly thrombocytopenic patients (preop levels < 20 K/μL), preop count was 11 ± 1 K/μL. A significant postsplenectomy platelet rise persisted for at least 1 year (137 ± 52 K/μL, P < 0.05 versus preop). An increased platelet level was observed in all hematologic subgroups; in the chronic leukemias (n = 58, P < 0.01) and in lymphoma (n = 59, P < 0.001), this reached significance. Mean platelet transfusions were significantly decreased from preop (3 months preop: 8.6 ± 2 units) compared with postsplenectomy (3 months postsplenectomy: 5.0 ± 1 unit, P = 0.03). This decrease was even more pronounced in profoundly thrombocytopenic patients (31.6 ± 10.6 units preop versus 8.9 ± 4.8 units postoperative, P = 0.01). CONCLUSIONS: In the hematologic malignancies, splenectomy produces a significant and longlasting restoration of platelet levels and a resultant decrease in platelet transfusion requirements. These beneficial effects of splenectomy hold true even for the most profoundly thrombocytopenic patients

Pit membranes of Ephedra resemble gymnosperms more than angiosperms

Bordered pit pairs of Ephedra species were characterized using different types of microscopy. Pit membranes contained tori that did not stain for lignin. SEM and AFM views of the torus surface showed no plasmodesmatal openings, but branched, secondary plasmodesmata were occasionally noted using TEM in conjunction with ultrathin sections. The margo consisted of radial microfibrils as well as finer diameter tangential fibrils. The former formed fascicles of fibrils that merged into even thicker buttresses during the act of pit membrane aspiration. AFM showed a discontinuous layer of non-microfibrillar material on the surface of both torus and margo. It is hypothesized that this material is responsible for adhesion of the pit membrane to the surface of the pit border during the process of aspiration. Taken as a whole, intervascular pit membranes of Ephedra more closely resemble those of conifers than those of torus-bearing pit membranes of angiosperms

Splenectomy in Haematological Patients

In the period from January 1990 to July 1998 we performed splenectomy on 129 patients of whom 77 were males and 52 females. The average age of patients was 4l.7 years, ranging from 7 to 76 years old. 38 of these (equal to 29.4%) underwent emergency operation owing to trauma (25 males and 13 females). In 3 patients (2 .3%) splenectomy was necessary owing to the existence of localised enlargements (aneurysms) of the splenic artery. This palticular motivation has gradually been reduced because of the growing possibility of embolizing a peripheral enlargement,or aneurysms in one of the branches of the subdivisions ofthe splenic artery. In 88 patients (68.3%) splenectomy was necessary due to the manifestation of splenomegaly in the development of spherocytos is, idiopathic thrombocytopenic purpura, or Werlhofs disease, fibro-congestive splenomegaly or in the presence of haemolytic or auto-immune diseases, or other pathològy. Patients affected with lymphomata or chronic myeloproliferative disorders are a case apart. For these patients the advisability of performing splenectomy is relative, and strictly connected to their clinical histories, and to the accuracy of diagnoses. In our group 48 male patients and 40 females were involved. Many laparosplenectomies performed in the past have been rendered useless, owing to the accuracy of clinico-pathology diagnostic systems such as TAC and RMN in confirming the presence or not of splenic infiltration and in diagnosing splenic lesions of uncertain nature. We chose to operate using median laparotomy, which allows good exposure ofthe whole abdominal cavity, even iftechnical difficulties can sometimes be met with atthe level ofthe upper sector, in the case of a voluminous spleen attached to the diaphragm