Background and aims Thrombocytopenia is a relatively common feature in systemic lupus erythematosus (SLE) patients, although severe thrombocytopenia is rare. Splenectomy is considered an acceptable treatment option for refractory thrombocytopenia in different haematological conditions. However, its role in SLE has been controversial, due to potential surgical complications and to its possible association with SLE flares. The aim of this study was to determine safety and efficacy of splenectomy in a cohort of SLE patients.

Methods We included all patients with SLE who fulfilled ≥4 ACR criteria, and underwent splenectomy between 2000 and 2015 in a tertiary care centre in Mexico City. Patients with other rheumatic diseases (except for anti-phospholipid syndrome) were excluded. We recorded demographic, clinical and serological characteristics at the time of surgery and during follow-up.

Results Thirty-six patients were included, 91.7% were women and mean age was 33.31±12.95. Refractory thrombocytopenia was the surgical indication in 28 patients (77.7%). Laparoscopic splenectomy was performed in 80.6% of cases. Two patients had surgical complications (intra-abdominal sepsis and pancreatic fistula). There were no deaths directly associated with the procedure. Among patients with thrombocytopenia, 85.7% achieved complete remission, in a mean period of 1.65±3.13 months. Cumulative prednisone dose in the year after the surgery was lower than the year before (8.7±5.8 vs 4.2±3.2 grams, p<0.01). Mean SLEDAI score at baseline was 3.53±2.9, and it decreased at 3 and 6 months (1.15±2.07 and 1.21±2.38, p<0.01, respectively) during follow-up.

Conclusions Splenectomy is a safe procedure in SLE patients, and it represents an effective therapeutic option for refractory thrombocytopenia.