The introduction of steroid therapy, red-blood-cell survival studies, and a better understanding of the pathology of congestive splenomegaly have all resulted in changing concepts of splenectomy. In the December issue of Archives of Surgery, Ashby and Ballinger1 review the current indications for splenectomy and emphasize the changes that have occurred with improved techniques of diagnosis and therapy.
The spleen produces changes in the peripheral blood by several mechanisms. For example, in congenital spherocytosis, the spleen destroys the abnormal red blood cells. In acquired idiopathic hemolytic anemia and idiopathic thrombocytopenic purpura, the spleen may produce autoimmune antibodies. Finally, in congestive splenomegaly, the spleen may also destroy normal blood cells which are trapped after stasis.
By suppression of the autoimmune mechanisms, steroid therapy has lessened the frequency with which splenectomy is utilized in the treatment of acquired idiopathic hemolytic anemia. Steroids are given initially in severe cases of acquired idiopathic hemolytic