Partial splenic artery embolization for idiopathic warm autoimmune hemolytic anemia refractory to medical therapy
Hadied M, Kherallah R, and Schwartz S. Partial splenic artery embolization for idiopathic warm autoimmune hemolytic anemia refractory to medical therapy. J Vasc Interv Radiol 2020; 31(3):S178.
J Vasc Interv Radiol
Purpose: While partial splenic artery embolization (PSAE) is a useful procedure that has been performed for a variety of indications including trauma and hypersplenism, it has been rarely described as a treatment for idiopathic warm autoimmune hemolytic anemia (AIHA). Previous reports in the literature are limited to case reports in situations that include the patient being a poor surgical candidate, the inability to transfuse blood during surgery because of autoantibodies, and a patient’s refusal of blood products on religious grounds. The purpose of this study is to demonstrate the utility of PSAE in the acute management of AIHA refractory to medical treatment. Materials: A case report describing the management of a 27-year-old male diagnosed with AIHA treated successfully with PSAE as a bridging therapy to definitive surgical splenectomy. Relevant laboratory results and imaging were extracted from the electronic medical record. Results: The patient was diagnosed with AIHA and treated with intravenous solumedrol and rituximab and received 12 units of RBCs at an outside institution. The patient was transferred to our institution after developing antibodies that precluded more transfusions. The decision was made to proceed with PSAE. The first hemoglobin post procedure was 4.5 g/dl, an increase from 2.1 g/dl pre procedure. After embolization, the patient remained in the inpatient setting for eight days. During the inpatient hospitalization the patient’s hemoglobin continued to trend upwards until it stabilized around 6 g/dl. Inpatient laboratory workup showed increasing haptoglobin, and decreasing LDH. After discharge, the patient developed persistent pain two months post procedure. An elective splenectomy was scheduled three months after the embolization procedure to address the persistent pain. Six months post embolization procedure and three months postoperatively, the patient is doing well clinically with a hemoglobin of 14 g/dl. Conclusions: In conclusion, this case demonstrates the utility of PSAE as an acute life-saving intervention for poor surgical candidates with idiopathic warm AIHA refractory to medical management.