Laparoscopic ligation of splenic vessels for the treatment of hereditary spherocytosis in children

The Effect of Laboratory Parameters on the Hospital Stay and Mortality in Pediatric Patients Who Underwent Lobectomy and Pneumonectomy

Background and Objectives: This study aims to evaluate the prognostic significance of various laboratory parameters in predicting the length of hospital stay and mortality among pediatric patients undergoing lobectomy and pneumonectomy for infectious or noninfectious diseases. Materials and Methods: This study was conducted by retrospective data analysis of 59 pediatric patients who underwent lobectomy and pneumonectomy due to variable diseases at the department of chest surgery. Pediatric patients diagnosed with variable diseases and who underwent lobectomy or pneumonectomy, patients who were hospitalized during the study period and underwent surgical intervention, and patients who had at least one laboratory parameter recorded before surgery were included in the study. Laboratory parameters included white blood cell (WBC) count, red cell distribution width (RDW), platelet (PLT) count, neutrophil count, mean platelet volume (MPV), monocyte count and lymphocyte count. Laboratory results were obtained from the patients' most recent blood samples before surgery. In addition, derived ratios such as platelet-to-lymphocyte ratio (PLR), MPV-to-PLT ratio (MPR), MPV-to-monocyte ratio (MMR), MPV-to-lymphocyte ratio (MPVLR), monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR), and Pan-Immune-Inflammation Value (PIV) were calculated and their potential prognostic values were evaluated. Results: The mean age of the patients was 6.3 years (0-15 years). The gender distribution of the patients in the study group was determined as 36 male patients (61%) and 23 female patients (39%). Lobectomy was the most commonly performed surgical procedure, accounting for 83% of cases, while pneumonectomy was applied in 17% of cases. The postoperative complication rate was observed as 34%. The mean hospital stay of the patients was calculated as 12.61 days (2-84 days), while the mortality rate was recorded as 8.5%. The relationship between the neutrophil count and the length of hospital stay is quite strong, and the r value was calculated as 0.550 (p < 0.01). PIV showed a strong correlation with length of hospital stay, with an r value of 0.650 (p < 0.01). A significant relationship was also found between PLR and length of hospital stay (r = 0.500, p < 0.01). The parameters with the highest positive effect on the hospital stay are neutrophil count (B = 0.400, p < 0.01) and PIV (B = 0.500, p < 0.01). The mean hospital stay was 10.00 days (2-30) in patients without complications and 15.00 days (5-40) in patients with complications, and this difference was also significant (p < 0.01). Finally, the mortality rate was 2.5% in patients without complications, while it was determined as 20% in those with complications (p < 0.01). Conclusions: This study determines the effects of laboratory parameters (particularly PIV, neutrophil, PLR, and NLR) on the duration of hospital stay, development of complications, and mortality and emphasizes the importance of monitoring these parameters in the treatment of infectious or noninfectious diseases.

Splenectomy improves erythrocyte functionality in spherocytosis based on septin abundance, but not maturation defects

Splenectomy improves the clinical parameters of patients with hereditary spherocytosis, but its potential benefit to red blood cell (RBC) functionality and the mechanism behind this benefit remain largely overlooked. Here, we compared 7 nonsplenectomized and 13 splenectomized patients with mutations in the β-spectrin or the ankyrin gene. We showed that hematological parameters, spherocyte abundance, osmotic fragility, intracellular calcium, and extracellular vesicle release were largely but not completely restored by splenectomy, whereas cryohemolysis was not. Affected RBCs exhibited decreases in β-spectrin and/or ankyrin contents and slight alterations in spectrin membrane distribution, depending on the mutation. These modifications were found in both splenectomized and nonsplenectomized patients and poorly correlated with RBC functionality alteration, suggesting additional impairments. Accordingly, we found an increased abundance of septins, small guanosine triphosphate-binding cytoskeletal proteins. Septins-2, -7, and -8 but not -11 were less abundant upon splenectomy and correlated with the disease severity. Septin-2 membrane association was confirmed by immunolabeling. Except for cryohemolysis, all parameters of RBC morphology and functionality correlated with septin abundance. The increased septin content might result from RBC maturation defects, as evidenced by (1) the decreased protein 4.2 and Rh-associated glycoprotein content in all patient RBCs, (2) increased endoplasmic reticulum remnants and endocytosis proteins in nonsplenectomized patients, and (3) increased lysosomal and mitochondrial remnants in splenectomized patients. Our study paves the way for a better understanding of the involvement of septins in RBC membrane biophysical properties. In addition, the lack of restoration of septin-independent cryohemolysis by splenectomy may call into question its recommendation in specific cases.

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

Background

Splenic infarction is a frequently missed diagnosis in acute clinical conditions and is often under-diagnosed due to the lack of high-quality evidence on pathophysiology of splenic infarction. Due to the scarcity of such evidence, no consensus guidelines regarding the diagnostic approach and management of patients with splenic infarction exist. Most of published articles on splenic infarction are case reports and there was no systematic review on splenic infarction.

Methods

We conducted a retrospective analysis of all radiologically confirmed cases of splenic infarction patients with any history of admission at National Center for Global Health and Medicine Kohnodai Hospital, from 2014 to 2020. Further, to understand the pathophysiology that causes splenic infarction, we searched the literatures on splenic infarction.

Results

We found 18 patients with splenic infarction. The average age was 78 years, and about half of patients had abdominal pain; however, the other half did not have abdominal pain. One-third of patients with splenic infarction died. Leukocytosis with neutrophilia, a decrease of lymphocytes, anemia, hypoalbuminemia, and liver dysfunction were observed. Fibrinogen was decreased and D-dimer was remarkably elevated. Lactate dehydrogenase (LDH) and C-reactive protein (CRP) were remarkably increased. Six patients (33.3%) had cancer, four patients (22.2%) had atrial fibrillation, and four patients (22.2%) had infection. We found 466 case reports on splenic infarction published from 1975 to 2021. Recently, the number of case reports on splenic infarction due to infection, especially, coronavirus disease 2019 (COVID-19), has been remarkably increasing. Furthermore, we found that leukocytosis, a decrease of lymphocytes, elongated activated partial thromboplastin time, decrease of fibrinogen, liver dysfunction, elevation of LDH and blood urea nitrogen can be the prognosis predicting factors for patients with splenic infarction.

Conclusion

Our study elucidated clinical, hematological, biochemical and radiological characteristics for patients with splenic infarction. We newly found significant differences in blood cell counts, coagulation markers, transaminases, LDH and blood urea nitrogen between patients who died and those who survived, suggesting that these parameters can be the prognosis predicting factors for splenic infarction. Further, our systematic review on case reports about splenic infarction showed the etiology of splenic infarction and the trend of the causative diseases.