Is splenectomy one of the contributory factors to pulmonary hypertension? An analysis of splenectomized hemolytic anemia and immune thrombocytopenia patients

The development of pulmonary hypertension (PH) after splenectomy is one of the recently controversial issues. This study aims to investigate whether splenectomy itself is an independent risk factor for the development of PH or if the primary contributor to PH development is the underlying condition that necessitated splenectomy. This study was conducted prospectively. We included 21 patients with immune thrombocytopenia (ITP) and 22 with hemolytic anemia. The patients' symptoms were assessed according to a questionnaire form. Blood tests, including N-terminal pro-B type natriuretic peptide (NT-proBNP) and D-dimer levels were done and the 6-minute walk test (6MWT) was performed. PH risk was evaluated using echocardiography (ECHO) and according to the study algorithm, Q-SPECT/CT (perfusion single-photon emission computed tomography/computed tomography) and right heart catheterization (RHC) were performed on selected patients for further assessment. Only one patient in the ITP group was diagnosed as group 2 PH based on ECHO findings and 3 patients with beta thalassemia in the hemolytic anemia group were diagnosed with group 4-5 PH by RHC. There was no statistically significant difference between ECHO-assessed risk for PH in splenectomized patients with hemolytic anemia and ITP (p > 0.05). ECHO risk for PH in the hemolytic anemia patients was found to be low in patients whose hemolysis decreased and transfusion needs disappeared after splenectomy. The results of the study suggest that the development of PH after splenectomy appears to be related to the underlying condition rather than the absence of the spleen.