Splenectomy and Cold Agglutinin Disease

Splenectomy, or the surgical removal of the spleen, can be an effective treatment for some types of hemolytic anemia and other blood disorders.

However, its benefits are far less clear for cold agglutinin disease (CAD).

What does the spleen do?

The spleen is a spongy organ, about the size of a fist, that is located on the upper left side of the abdomen. The organ is responsible for filtering the blood and removing unwanted materials, such as blood cells that are damaged, old, or abnormal. The spleen is also one of the places where B-cells, or immune cells that produce antibodies, mature. As such, it helps in fighting infections.

What happens to the spleen in CAD?

In CAD, the immune system mistakenly produces autoantibodies which, in cold temperatures, bind to red blood cells and cause them to be destroyed. Debris from these red blood cells is filtered primarily by the liver, but some of it is also cleared out through the spleen.

The considerable increase in blood-borne debris that follows a CAD crisis can overwhelm the liver and spleen. This causes the spleen to become enlarged, a condition known as splenomegaly, and can be painful.

Splenectomy

A splenectomy is a surgical procedure to remove the spleen. In severe cases, this is the only effective treatment for an enlarged spleen.

Without the spleen, B-cells have trouble maturing. This can lower the production of harmful antibodies in some cases, but how it is not clear how long this benefit may last in CAD.

A splenectomy also increases the risk of blood clots occurring and risks making patients more susceptible to infections. As with any major surgery, splenectomy also carries other risks, including bleeding, infection, and damage to nearby organs.

Last updated: Feb. 5, 2020

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