Preserved splenic function after angioembolisation of high grade injury.
BACKGROUND
After introducing splenic artery embolisation (SAE) in the institutional treatment protocol for splenic injury, we wanted to evaluate the effects of SAE on splenic function and assess the need for immunisation in SAE treated patients.


METHODS
15 SAE patients and 14 splenectomised (SPL) patients were included and 29 healthy blood donors volunteered as controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears from all patients and controls were examined for Howell-Jolly (H-J) bodies. Abdominal doppler, gray scale and contrast enhanced ultrasound (CEUS) were performed on all the SAE patients.


RESULTS
Leukocyte and platelet counts were elevated in both SAE and SPL individuals compared to controls. The proportion of memory B-lymphocytes did not differ significantly from controls in either group. In the SAE group total IgA, IgM and IgG levels as well as pneumococcal serotype specific IgG and IgM antibody levels did not differ from the control group. In the SPL group total IgA and IgG Pneumovax(®) (PPV23) antibody levels were significantly increased, and 5 of 12 pneumococcal serotype specific IgGs and IgMs were significantly elevated. H-J bodies were only detected in the SPL group. CEUS confirmed normal sized and well perfused spleens in all SAE patients.


CONCLUSIONS
In our study non-operative management (NOM) of high grade splenic injuries including SAE, was followed by an increase in total leukocyte and platelet counts. Normal levels of immunoglobulins and memory B cells, absence of H-J bodies and preserved splenic size and intraparenchymal blood flow suggest that SAE has only minor impact on splenic function and that immunisation probably is unnecessary.
Skattum
Jorunn
J
Trauma Unit, Oslo University Hospital Ullevaal, Kirkeveien 166, N-0407 Oslo, Norway. joet@uus.no
Titze
Thomas Larsen
TL
Dormagen
Johann Baptist
JB
Aaberge
Ingeborg S
IS
Bechensteen
Anne Grete
AG
Gaarder
Per Ivar
PI
Gaarder
Christine
C
Heier
Hans Erik
HE
Næss
Pål Aksel
PA
D000328:Adult; D001402:B-Lymphocytes / Q000276:immunology; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D016233:Immunotherapy, Active; D015601:Injury Severity Score; D008213:Lymphocyte Activation; D008297:Male; D013154:Spleen / Q000276:immunology / Q000293:injuries / Q000503:physiopathology*; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000276:immunology / Q000503:physiopathology*; D016896:Treatment Outcome; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000276:immunology / Q000628:therapy*