Plasma cell dyscrasias are a group of clinically and biochemically diverse disorders of unknown etiology, characterized by the disproportionate proliferation of one or more clones of B cells, and the presence of a structurally and electrophoretically homogeneous (monoclonal)
immunoglobulin or
polypeptide subunit in serum or urine. The role of
splenectomy in the management of
plasma cell dyscrasias has not been well defined. Using MEDLINE, the authors searched the English-language published literature from the year 1970 through September 2005 to determine the indications for
splenectomy in
plasma cell dyscrasias. A review of the literature in humans and animals supported the idea that the spleen provides a special microenvironment favorable for homing or differentiation of
IgM producing B cells, and
splenectomy can, at times, lead to remission in Waldenström's
macroglobulinemia. The other reported reasons for
splenectomy in
plasma cell dyscrasias are
hypersplenism-related
pancytopenia, control of splenic
plasmacytomas, and management of a splenic
abscess. Splenic infiltration in
primary amyloidosis can be an indication for
splenectomy, where removal of a large spleen can also reverse an acquired
factor X deficiency. Thus, the spleen can be considered a potential target organ for management of
plasma cell dyscrasias, and therapeutic success has been achieved with removal of this organ. However,
splenectomy can be a potentially morbid procedure in patients with
plasma cell dyscrasias, and major postoperative complications include
infection,
hemorrhage, and
thrombosis.