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        Splenic myeloid metaplasia in warm autoimmune hemolytic anemia (wAIHA): a retrospective study

        Víctor Manuel Anguiano-Álvarez,Alonso Hernández-Company,Nashla Hamdan-Pérez,Daniel Montante-M,Diego A. Zúñiga-Tamayo,Sergio Rodríguez-Rodríguez,Alan Pomerantz,Elena J. Tuna-Aguilar 대한혈액학회 2018 Blood Research Vol.53 No.1

        BackgroundSplenic myeloid metaplasia (SMM) is a kind of extramedullary hematopoiesis, whereasits clinical significance in wAIHA remains unclear. The aim of this study is evaluating thefrequency and clinical characteristics of SMM, compared with splenic-congestion (SC). MethodsWe included patients with wAIHA treated in a Mexican tertiary hospital between January1992 and December 2015. All patients received steroids as first-line treatment and splenectomyas second-line treatment. ResultsAmong the thirty-six splenectomized patients, 15 (41.6%) and 21 (58.4%) were diagnosedas SMM and SC, respectively. No differences were found in clinical characteristicsbetween two groups. SMM patients showed lower platelet count (147×109/L vs. 240×109/L, P=0.02) and higher presence of anti-dsDNA antibodies (40% vs. 4.7%,P=0.01) than SC patients. Although the complete response (CR) rate with first-line treatmentwas lower in SMM patients (13.3% vs. 47.6%; P=0.04), post-splenectomy mediandisease-free-survival (DFS) was longer (16.2 mo vs. 5.1 mo; P=0.19). Univariate/multivariateanalysis showed that achieving CR during first-line treatment (OR 0.3, 95% CI:0.03‒0.94, P=0.03) and higher platelet count (OR 0.99, 95% CI: 0.98‒0.99, P=0.03)were protective factors for SMM; and anti-dsDNA titer higher than 9.6 IU/dL was a riskfactor for SMM (OR 2.76, 95% CI: 1.48‒5.14, P<0.001). ConclusionThe wAIHA patients with SMM have different biological profiles with those without SMM. This study is the first trial evaluating the significance of histopathological spleen findingsand their association with rheumatologic profile.

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