Functional asplenia after bone marrow transplantation. A late complication related to extensive chronic graft-versus-host disease.

STUDY OBJECTIVE

To evaluate splenic function in bone marrow transplant recipients, with relation to chronic graft-versus-host disease and infections.

DESIGN

Survey, outpatients geographically accessible for voluntary participation.

SETTING

Bone marrow transplantation referral center.

PATIENTS

Fifteen bone marrow graft recipients (13 allogeneic, 2 autologous), out of a total of 33 patients who received transplants at the center and survived more than 6 months after grafting.

MEASUREMENTS AND MAIN RESULTS

In 6 of 15 patients impaired splenic function (functional asplenia) was indicated by the presence of Howell-Jolly bodies in peripheral blood smears, reduced spleen size (P less than 0.001), higher platelet counts (P less than 0.01), higher indium-111 labeled autologous platelet recovery (P less than 0.005), reduced splenic blood flow (P less than 0.001), and reduced accumulation of radioactivity at the splenic site (P less than 0.001). All patients with functional asplenia but only 2 patients without functional asplenia had extensive chronic graft-versus-host disease. The incidence of bacterial infections was four times higher in patients with impaired splenic function.

CONCLUSIONS

Functional asplenia is a late complication after allogeneic bone marrow transplantation and contributes to the high susceptibility to bacterial infections in patients with extensive chronic graft-versus-host disease.