Partial Splenic Embolization for the Management of Severe Refractory Thrombocytopenia in Antiphospholipid Syndrome: A Case Report and Literature Review

Antiphospholipid syndrome is an autoimmune condition characterized by arteriovenous thromboembolic events. Thrombocytopenia is a common finding among these patients and is typically of mild severity not requiring any treatment. However, severe cases of thrombocytopenia should be treated. Steroids, intravenous immune globulin (IVIG), and immunomodulatory agents are the first-line treatment options, and surgical splenectomy is usually reserved for more severe and refractory cases of thrombocytopenia. Herein, we report the case of a 30-year-old man with primary antiphospholipid syndrome and severe thrombocytopenia. The patient’s thrombocytopenia had been refractory to almost all the medical managements, and surgical splenectomy could not be an option due to the patient’s high-risk condition for surgery. The patient was successfully managed by partial splenic embolization (PSE) which was a unique application of this technique.

Quantitative splenic embolization possible: application of 8Spheres conformal microspheres in partial splenic embolization (PSE)

Background To investigate the safety and efficacy of 8Spheres in partial splenic embolization. To explore the possibility of accurate control of splenic embolic volume by quantifying the number of microspheres used during PSE. Method The data of 179 patients who underwent PSE were collected. The patients were divided into two groups: 300–500 um microsphere group (N = 83) and 500–700 um microsphere group (N = 96). The spleen volume before PSE, infarct volume and infarct rate of the spleen after PSE, changes in peripheral blood cells after PSE, postoperative adverse events and incidence of infection were compared between the two groups. Results 300–500 um group vs 500–700 um group: postoperative spleen volume (cm3): 753.82 ± 325.41 vs 568.65 ± 298.16 (P = 0.008); spleen embolization volume (cm3): 525.93 ± 118.29 vs 630.26 ± 109.71 (P = 0.014); spleen embolization rate: 41.1 ± 12.3% vs 52.4 ± 10.1% (P = 0.021). Leukocytes and platelets were significantly increased after PSE in both groups; leukocyte, 1 month: 4.13 ± 0.91 vs 5.08 ± 1.16 (P = 0.026); 3 months: 4.08 ± 1.25 vs 4.83 ± 0.98 (P = 0.022); platelet, 1 month: 125.6 ± 20.3 vs 138.7 ± 18.4 (P = 0.019); 3 months: 121.8 ± 16.9 vs 134.3 ± 20.1 (P = 0.017). Incidence of abdominal pain after PSE, 72 (86.7%) vs 69 (71.9%), P = 0.027. The incidence of other adverse events and infections after PSE was not statistically different. Conclusion PSE with 8Spheres is safe and effective. The use of 500–700 um microsphere for PSE can make the increase of peripheral blood cells more stable. Each vial of 8Spheres corresponds to a certain volume of splenic embolization, so it is possible to achieve quantitative embolization in PSE.

Super-selective Partial Splenic Embolization for Hereditary Spherocytosis in Children: A Single-Center retrospective Study

Hereditary spherocytosis is the most common cause of hemolytic anemia due to defects in the blood cell membrane. Partial splenic embolization (PSE) might significantly improve the effects of hemolysis in HS patients while preserving partial splenic function. However, due to the poor controllability of the scope of interventional embolization, PSE in pediatric HS had not been widely studied and applied. The present study is the first to propose that optimized PSE procedure to treat pediatric HS patients, which named super-selective partial splenic embolization (SPSE). We investigated the feasibility and effectiveness of SPSE. This study was conducted by retrospectively reviewing clinical data from HS patients treated by surgical treatments who were diagnosed at children’s hospital of Chongqing medical university from January 2015 to December 2019. Patients were divided into two groups according to treatment preference: SPSE (16 patients) group and total splenectomy (41 patients) group. The data were analyzed such as preoperative and postoperative leukocytes, hemoglobin, platelets, bilirubin, immunological indicators, and postoperative complications. The success rate of two groups were 100%. The improvement of hemolysis in patients after SPSE was not different from that after total splenectomy, and the effect can be maintained for a long time. The average hemoglobin value increased significantly from 6.97g/dL before SPSE to 12.2g/dL after SPSE (P=0.000). SPSE was performed without any serious complications. SPSE is a safe and effective treatment for moderate or severe HS in children.