What hematologic disease has the highest postoperative morbidity after splenectomy: idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, myeloid dysplasia, sickle cell anemia, or thalassemia?

From the Guidelines

The answer is (a) idiopathic thrombocytopenic purpura, as postoperative morbidity after splenectomy for this condition is significant due to the potential for serious short- and long-term risks, including surgical complications, infections, thromboembolism, and possibly an increased incidence of malignancy 1.

Postoperative Morbidity Considerations

When considering postoperative morbidity after splenectomy for hematologic diseases, several factors come into play, including the underlying disease process, the patient's overall health status, and the potential complications associated with splenectomy itself.

• Idiopathic thrombocytopenic purpura (ITP) is a condition where the immune system destroys platelets, leading to an increased risk of bleeding. Splenectomy is often considered for long-term management of ITP due to its potential to induce long-term remission, with an initial response rate of up to 85% 1.
• However, splenectomy for ITP is associated with significant risks, including surgical complications in up to 10% of patients within the 30-day postoperative period, even with less-invasive laparoscopic methods 1.
• Additionally, the lack of splenic function following splenectomy may result in increased risks of infections, thromboembolism, and possibly malignancy, contributing to a higher risk of death that persists for more than 10 years after surgery 1.

Comparison with Other Conditions

In comparison to other hematologic diseases such as hereditary spherocytosis, myeloid dysplasia, sickle cell anemia, and thalassemia, the postoperative morbidity associated with splenectomy for ITP stands out due to its unique combination of immune system dysfunction and potential for severe complications.

• While patients with sickle cell anemia, for example, are at risk for serious complications following surgery, including acute chest syndrome and vaso-occlusive crises, the overall risk profile for postoperative morbidity after splenectomy may not be as high as that seen in ITP patients.
• Similarly, patients with hereditary spherocytosis, myeloid dysplasia, and thalassemia may have specific risks associated with their conditions, but these do not necessarily outweigh the risks seen in ITP patients undergoing splenectomy.

Conclusion Not Applicable - Direct Answer Only

Therefore, based on the available evidence, the highest postoperative morbidity after splenectomy for hematologic diseases is seen in patients with idiopathic thrombocytopenic purpura, making option (a) the correct answer 1.

From the Research

Postoperative Morbidity after Splenectomy

The question of which hematologic disease has the highest postoperative morbidity after splenectomy can be addressed by examining the provided evidence.

• The study 2 found that patients with myelofibrosis had the highest incidence of complications (50%) and the highest postoperative mortality (21%; p = 0.04) after splenectomy.
• However, myelofibrosis is not listed among the options provided.
• Another study 3 reported that patients treated for malignant disease had a higher rate of overall complications (27.2%) compared with patients treated for benign disease (14.1%) (P < .001).
• The options provided include idiopathic thrombocytopenic purpura, hereditary spherocytosis, myeloid dysplasia, sickle cell anemia, and thalassemia.
• Myeloid dysplasia is another term for myelodysplastic syndrome (MDS), which is a type of malignant hematologic disease.
• Based on the information provided, it can be inferred that myeloid dysplasia (or MDS) may have a higher postoperative morbidity after splenectomy compared to the other options listed.

Comparison of Options

• Idiopathic thrombocytopenic purpura (ITP) is a benign hematologic disorder, and the studies provided do not suggest a high postoperative morbidity for this condition.
• Hereditary spherocytosis is also a benign hematologic disorder, and the evidence does not indicate a high postoperative morbidity for this condition.
• Sickle cell anemia and thalassemia are both benign hematologic disorders, and the studies provided do not suggest a high postoperative morbidity for these conditions.
• Myeloid dysplasia, on the other hand, is a malignant hematologic disease, and the evidence suggests that malignant diseases may have a higher postoperative morbidity after splenectomy.

Conclusion Based on Available Data

Based on the available data, it appears that myeloid dysplasia (option c) may have the highest postoperative morbidity after splenectomy among the options provided, due to its classification as a malignant hematologic disease 3. However, it is essential to note that the direct comparison of postoperative morbidity among these specific conditions is not explicitly stated in the provided studies.