Blood Res.  2018 Mar;53(1):35-40. 10.5045/br.2018.53.1.35.

Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

• Anguiano-Álvarez VM
• Hernández-Company A
• Hamdan-Pérez N
• Montante-M D
• Zúñiga-Tamayo DA
• Rodríguez-Rodríguez S
• Pomerantz
• Tuna-Aguilar EJ

• KMID: 2414362
• DOI: http://doi.org/10.5045/br.2018.53.1.35

Abstract

BACKGROUND
Splenic myeloid metaplasia (SMM) is a kind of extramedullary hematopoiesis, whereas its clinical significance in wAIHA remains unclear. The aim of this study is evaluating the frequency and clinical characteristics of SMM, compared with splenic-congestion (SC).
METHODS
We included patients with wAIHA treated in a Mexican tertiary hospital between January 1992 and December 2015. All patients received steroids as first-line treatment and splenectomy as second-line treatment.
RESULTS
Among the thirty-six splenectomized patients, 15 (41.6%) and 21 (58.4%) were diagnosed as SMM and SC, respectively. No differences were found in clinical characteristics between two groups. SMM patients showed lower platelet count (147×109/L vs. 240×109/L, P=0.02) and higher presence of anti-dsDNA antibodies (40% vs. 4.7%, P=0.01) than SC patients. Although the complete response (CR) rate with first-line treatment was lower in SMM patients (13.3% vs. 47.6%; P=0.04), post-splenectomy median disease-free-survival (DFS) was longer (16.2 mo vs. 5.1 mo; P=0.19). Univariate/multivariate analysis showed that achieving CR during first-line treatment (OR 0.3, 95% CI: 0.03-0.94, P=0.03) and higher platelet count (OR 0.99, 95% CI: 0.98-0.99, P=0.03) were protective factors for SMM; and anti-dsDNA titer higher than 9.6 IU/dL was a risk factor for SMM (OR 2.76, 95% CI: 1.48-5.14, P < 0.001).
CONCLUSION
The wAIHA patients with SMM have different biological profiles with those without SMM. This study is the first trial evaluating the significance of histopathological spleen findings and their association with rheumatologic profile.

Keyword

Warm autoimmune hemolytic anemia; Splenic myeloid metaplasia; Splenic-congestion; Extramedullary hematopoiesis

MeSH Terms

Anemia, Hemolytic, Autoimmune*
Antibodies
Hematopoiesis, Extramedullary
Humans
Platelet Count
Primary Myelofibrosis*
Protective Factors
Retrospective Studies*
Risk Factors
Spleen
Splenectomy
Steroids
Tertiary Care Centers
Antibodies
Steroids

Figure

• 

  Fig. 1 Consolidated Standards of Reporting Trials (CONSORT) diagram of this study.

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  Fig. 2 Event-free survival after splenectomy. Event-free survival after splenectomy was 16.2 months in patients with MME versus 5.1 months in the splenic congestion group (P=0.19).

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