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Defective spleen function in autoimmune gastrointestinal disorders.

Paolo Giuffrida1, Nicola Aronico1, Matteo Rosselli2

  • 1First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.

Internal and Emergency Medicine
|June 20, 2019
PubMed
Summary

Autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE), and autoimmune liver disease (AILD) are linked to spleen dysfunction. Patients with these conditions should be screened for hyposplenism and considered for bacterial vaccine prophylaxis.

Keywords:
Autoimmune atrophic gastritisAutoimmune enteropathyAutoimmune liver diseaseCoeliac diseasePitted red cellUlcerative colitis

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Area of Science:

  • Immunology
  • Hematology
  • Gastroenterology

Background:

  • Defective spleen function elevates susceptibility to bacterial infections, preventable by vaccines.
  • Splenic hypofunction is documented in various autoimmune disorders.
  • Data on splenic function in autoimmune atrophic gastritis (AAG), autoimmune enteropathy (AIE), and autoimmune liver disease (AILD) were lacking.

Purpose of the Study:

  • To investigate the prevalence of splenic hypofunction in patients with AAG, AIE, and AILD.
  • To assess the utility of pitted red cell count as an indicator of spleen function in these autoimmune conditions.
  • To determine the need for vaccine prophylaxis in patients with autoimmune gastrointestinal and liver diseases.

Main Methods:

  • Peripheral blood samples were collected from patients diagnosed with AAG (n=40), AIE (n=3), and AILD (n=40).
  • Patients with coeliac disease (CD) and ulcerative colitis (UC) were included as disease controls.
  • Pitted red cell count was used to assess spleen function, with a normal upper limit of 4%.

Main Results:

  • Splenic hypofunction was detected in 55.0% of AAG patients, 66.6% of AIE patients, and 87.5% of AILD patients.
  • Hyposplenism was also prevalent in disease controls: untreated CD (43.7%), refractory CD (88.2%), and UC (54.4%).
  • A significant proportion of patients with AAG, AIE, and AILD exhibited defective splenic function.

Conclusions:

  • High prevalence of splenic hypofunction in AAG, AIE, and AILD necessitates routine evaluation.
  • Pitted red cell count is a valuable indicator for identifying hyposplenism in these patient groups.
  • Patients with AAG, AILD, and AIE who are hyposplenic should be considered for prophylactic vaccination against encapsulated bacteria.