Reduced Transfusion Requirements in a Splenectomized Patient Undergoing Bone Marrow Transplantation

Dr. Rodrigo Martino, Department d’Hematologia, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Maria Claret, 167, E08025 Barcelona (Spain) The spleen is an essential organ in normal platelet kinetics. Especially in splenomegalic subjects, a large proportion of transfused platelets are sequestered and/or destroyed in this organ [1]. Thus, it is not surprising that the transfusion requirements of splenectomized patients undergoing bone marrow transplantation (BMT) are lower than those of splenomegalic patients although few reports specifically address this issue [2]. We describe such a case and compare the transfusion needs with a group of comparable nonsplenomegalic subjects. Acute lymphoblastic leukemia was diagnosed in a 43-year-old woman after a spontaneous splenic rupture [3]. Complete remission was obtained with induction chemotherapy, followed by two courses of consolidation therapy. In October 1993, an allogeneic BMT from an HLAidentical and ABO-compatible brother was performed. The clinical course during BMT was uncomplicated except for a 4-day episode of granulocytopenic fever which resolved with empirical antibiotics. Pancytopenia was less severe than expected, as seen in figure 1 ‚ and she prophy-lactically received only 13 units of random-donor platelets (pooled in two transfusions); no RBC transfusions were needed. Hematopoietic recovery was mediated by 100% donorderived cells. Grade 2 acute graft-versus-host disease (AGVHD) developed, easily controlled with prednisone. The patient is currently well, 10 months after BMT. From late 1990 to late 1993, 59 adults underwent an allogeneic BMT from an HLA-identical sibling at our institution. Those with aplastic anemia, relapsed acute leukemia at BMT, chronic myelogenous leukemia (CML) | I I I I ¦ ! I I I | I I ! I | I I I I [ I I I 5 10 15 20 25 30 Days after BMT Fig. 1. Levels of WBC (■), PLT (A) and Hb (▼) from day 0 and until complete hematologic recovery. The arrows indicate platelet transfusions.