An extreme consequence of splenectomy in dehydrated hereditary stomatocytosis: gradual thrombo-embolic pulmonary hypertension and lung-heart transplantation.
Dehydrated hereditary stomatocytosis (DHS) belongs to the heterogeneous class of hemolytic anemias with leaky red cell membranes. Splenectomy is a highly deleterious treatment, because it favors, with virtually no exception, the occurrence of thromboembolic disease. We describe here the extreme case of a patient with DHS and an associated sickle cell trait. Splenectomy was carried out due to a splenic infarction that occurred during an airplane journey. About 12 years later, the patient noticed an exertional dyspnea, which gradually worsened to such a degree that she became severely incapacitated within 5 years. Eventually, the patient developed a cor pulmonale associated with chronic thromboembolic pulmonary hypertension (CTEPH) and successfully underwent a heart-lung transplant operation. This case ranks as one of the most severe examples ever recorded of the effect that splenectomy may have in DHS patients. Nonetheless, it represents the first case to receive a heart-lung transplant.
Jaïs
Xavier
X
UPRES EA 2705, Service de Pneumologie, Hôpital Antoine-Béclère (AP-HP, Université Paris-Sud), Clamart, France.
Till
Stephen J
SJ
Cynober
Thérèse
T
Ioos
Vincent
V
Garcia
Gilles
G
Tchernia
Gil
G
Dartevelle
Philippe
P
Simonneau
Gérald
G
Delaunay
Jean
J
Humbert
Marc
M
D000328:Adult; D000745:Anemia, Hemolytic, Congenital / Q000150:complications / Q000601:surgery*; D000755:Anemia, Sickle Cell / Q000150:complications; D004417:Dyspnea; D005260:Female; D016041:Heart-Lung Transplantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011655:Pulmonary Embolism / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D013156:Splenectomy / Q000009:adverse effects*; D016896:Treatment Outcome