Splenectomy in onyalai. A report on 5 cases

Area of Science:

• Hematology
• Immunology
• Surgical Oncology

Background:

• Onyalai, an acquired immune thrombocytopenia, presents a significant mortality risk (10%) with severe bleeding.
• Conventional treatments like corticosteroids and blood transfusions are not consistently effective in managing severe onyalai.
• This study investigates splenectomy as a therapeutic option for patients with refractory onyalai.

Observation:

• Five patients with severe, uncontrollable onyalai underwent splenectomy.
• Pre-operative screening excluded malaria, sickle-cell anemia, and bilharzia.
• Patients received Vitamin K, epsilon-aminocaproic acid, and fresh blood transfusion during surgery.

Findings:

• Splenectomy resulted in cessation of bleeding and increased platelet counts within 24 hours in all patients.
• Three patients achieved sustained normal platelet counts and remained disease-free for over 500 days.
• Two patients experienced recurrent bleeding, leading to fatal cerebral hemorrhage and hemorrhagic shock.

Implications:

• Splenectomy is a viable option for severe onyalai cases unresponsive to conservative management.
• Careful patient selection and monitoring are crucial due to the risk of recurrence and potential mortality.
• Further research is needed to optimize long-term outcomes and understand recurrence patterns in onyalai patients post-splenectomy.