Functional Asplenia after Bone Marrow Transplantation

A Late Complication Related to Extensive Chronic Graft-Versus-Host Disease

  1. Peter Kalhs, MD;
  2. Simon Panzer, MD;
  3. Kurt Kletter, MD, PhD;
  4. Erich Minar, MD;
  5. Milena Stain-Kos, MD;
  6. Reinhard Walter, MD;
  7. Klaus Lechner, MD; and
  8. Wolfgang Hinterberger, MD

    Abstract

    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.

    Article and Author Information

    • From the University of Vienna, Vienna, Austria. For current author addresses, see end of text.

    • 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.

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    1. Ann Intern Med September 15, 1988 vol. 109 no. 6 461-464
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