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Splenic rupture following lenograstim in post-autologous stem cell transplantation treated with emergency open splenectomy: a case report and literature review.

ABSTRACT: Granulocyte-colony stimulating factors (G-CSFs) are the cornerstone of peripheral blood stem cell mobilization and apheresis. However, splenic rupture following G-CSF treatment represents a serious and potentially fatal adverse event. Here, we report the case of a patient in their late 50s with severe pancytopenia post-autologous stem cell transplantation reinfusion suffering from splenic rupture after treatment with lenograstim. We also reviewed the literature describing cases of splenic rupture during G-CSF administration.

SUBMITTER: Markovic U

PROVIDER: S-EPMC9160916 | biostudies-literature | 2022 May

REPOSITORIES: biostudies-literature

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Splenic rupture following lenograstim in post-autologous stem cell transplantation treated with emergency open splenectomy: a case report and literature review.

Markovic Uros U Colarossi Cristina C Iuppa Antonio A Scire Paola P Gorgone Ausilia A Galbo Federica F Amato Gabriella G Moschetti Gaetano G

The Journal of international medical research 20220501 5

Granulocyte-colony stimulating factors (G-CSFs) are the cornerstone of peripheral blood stem cell mobilization and apheresis. However, splenic rupture following G-CSF treatment represents a serious and potentially fatal adverse event. Here, we report the case of a patient in their late 50s with severe pancytopenia post-autologous stem cell transplantation reinfusion suffering from splenic rupture after treatment with lenograstim. We also reviewed the literature describing cases of splenic ruptur ...[more]

PMID: 35638556

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Project description:BackgroundSplenic rupture associated with trauma is common within the population, however, spontaneous splenic rupture is noted to be a rarity in clinical practice. Spontaneous splenic rupture is usually associated with hematologic, neoplastic, or infectious disorders, with infectious mononucleosis associated with Epstein-Barr virus being the most common cause worldwide. Spontaneous splenic rupture without underlying cause is thought to be exceedingly rare. In this article we present a case involving a true spontaneous splenic rupture.Case descriptionWe present the case of a 73-year-old female with past medical history significant for hypothyroidism, hypertension, squamous cell carcinoma of the chest, and history of tobacco use who presented to the emergency department with acute onset of left-sided flank pain radiating to her shoulder beginning three days prior. Computed tomography of the abdomen and pelvis without contrast revealed an acute splenic injury concerning for rupture with contour obscured by blood products with associated mild to moderate hemoperitoneum. The decision was made to proceed with emergent exploratory laparotomy and splenectomy. Patient received her post splenectomy vaccinations. On follow-up appointment, patient was noted to be doing well.ConclusionsThis case highlights the importance of early diagnosis and treatment of atraumatic splenic rupture, as delayed diagnosis and treatment is associated with significant morbidity and mortality. Operative intervention including splenectomy remains the mainstay of treatment, in addition to appropriate resuscitation. Some authors have reported cases in which hemodynamically stable patients are able to be treated non-operatively, however, the long-term consequences are unknown. Atraumatic spontaneous splenic rupture is often low on the differential diagnoses due to its rarity. Unfortunately, it carries a high risk of morbidity and mortality, and thus timely diagnosis and intervention is imperative.

Project description:BackgroundNon-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources.MethodsData on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed.Findings4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate.InterpretationThe post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries.FundingThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Splenic rupture following lenograstim in post-autologous stem cell transplantation treated with emergency open splenectomy: a case report and literature review.

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Splenic rupture following lenograstim in post-autologous stem cell transplantation treated with emergency open splenectomy: a case report and literature review.

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