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Functional Asplenia after Bone Marrow Transplantation: A Late Complication Related to Extensive Chronic Graft-Versus-Host Disease

Peter Kalhs, MD; Simon Panzer, MD; Kurt Kletter, MD, PhD; Erich Minar, MD; Milena Stain-Kos, MD; Reinhard Walter, MD; Klaus Lechner, MD; and Wolfgang Hinterberger, MD
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Grant Support: Partial support by grants from the Medizinish-Wissenschaftlicher Fonds des Bürgermeisters der Bundeshauptstadt Wein. Dr. Stain-Kos was the recipient of grants from the Kommission für Leukämieforschung und Knochenmarktransplantation of the Austrian Academy of Sciences.

Requests for Reprints: Peter Kalhs, MD, First Medical Clinic, Division of Hematology, University of Vienna, Lazarettgasse 14, A-1090 Vienna, Austria.

Current Author Addresses: Drs. Kalhs, Panzer, Kletter, Minar, Stain-Kos, Walter, Lechner, and Hinterberger: First Medical Clinic, University of Vienna, Vienna, Austria.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(6):461-464. doi:10.7326/0003-4819-109-6-461
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Study Objective: To evaluate splenic function in bone marrow transplant recipients, with relation to chronic graft-versus-host disease and infections.

Design: Survey, outpatients geographically accessible for voluntary participation.

Setting: Bone marrow transplantation referral center.

Patients: Fifteen bone marrow graft recipients (13 allogeneic, 2 autologous), out of a total of 33 patients who received transplants at the center and survived more than 6 months after grafting.

Measurements and Main Results: In 6 of 15 patients impaired splenic function (functional asplenia) was indicated by the presence of Howell-Jolly bodies in peripheral blood smears, reduced spleen size (P < 0.001), higher platelet counts (P < 0.01), higher indium-111 labeled autologous platelet recovery (P < 0.005), reduced splenic blood flow (P < 0.001), and reduced accumulation of radioactivity at the splenic site (P < 0.001). All patients with functional asplenia but only 2 patients without functional asplenia had extensive chronic graft-versus-host disease. The incidence of bacterial infections was four times higher in patients with impaired splenic function.

Conclusions: Functional asplenia is a late complication after allogeneic bone marrow transplantation and contributes to the high susceptibility to bacterial infections in patients with extensive chronic graft-versus-host disease.





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