Conservative management of splenic rupture in an elderly patient with Hodgkin lymphoma on Filgrastim
DOI:
https://doi.org/10.18203/2349-2902.isj20261576Keywords:
Spleen, , Splenomegaly, Filgrastim, Hodgkin, Management, RuptureAbstract
The spleen plays a substantial role in the human body, with major functions including eliminating abnormal erythrocytes, and producing immunoglobulins. Splenomegaly is a condition affecting around two-percent (2%) of the US population. It can occur secondary to hemoglobinopathies such as hereditary spherocytosis, infectious mononucleosis (i.e., Epstein-Barr virus, cytomegalovirus, etc.), sporadic venous anomalies, and drug reactions. Certain medications have been recently implicated with splenomegaly. Granulocyte-colony stimulating factor (G-CSF) used in patients undergoing chemotherapy or blood stem cell transplants recipients (PBSCT) has been increasingly reported in association with splenic injury secondary to splenomegaly. The enlarged spleen carries an increased risk for spontaneous or traumatic rupture. Management of splenic injury is a highly streamlined process. Indications for operative versus non-operative management (NOM) rely mainly on hemodynamic status of the patient, grade of splenic injury, as well as the presence of other injuries, comorbidities, and etiology of the splenomegaly. In ruptures associated with hemoglobinopathies, erythrocyte membrane disorders, lymphoproliferative and myeloproliferative disorders, splenectomy is more often chosen. The current guidelines favor conservative approaches for hemodynamically stable patients. Whereas for those who fail conservative management or are hemodynamically unstable, considerations for interventional radiology involvement or emergent operative management are indicated. We present a patient with Hodgkin’s lymphoma, being treated with GCSF (filgrastim) and who developed splenomegaly with subsequent splenic rupture.
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