Functional Asplenia after Bone Marrow Transplantation

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Abstract
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 < 0.001), higher platelet counts (P < 0.01), higher indium-111 labeled autologous platelet recovery (P < 0.005), reduced splenic blood flow (P < 0.001), and reduced accumulation of radioactivity at the splenic site (P < 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.