{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:02:10Z","timestamp":1774882930332,"version":"3.50.1"},"reference-count":120,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T00:00:00Z","timestamp":1694217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Autoimmune hemolytic anemia (AIHA) is a rare, very heterogeneous, and sometimes life-threatening acquired hematologic disease characterized by increased red blood cell (RBC) destruction by autoantibodies (autoAbs), either with or without complement involvement. Recent studies have shown that the involvement of T- and B-cell dysregulation and an imbalance of T-helper 2 (Th2) and Th17 phenotypes play major roles in the pathogenesis of AIHA. AIHA can be primary (idiopathic) but is more often secondary, triggered by infections or drug use or as a part of other diseases. As the location of origin of autoAbs and the location of autoAb-mediated RBC clearance, as well as the location of extramedullary hematopoiesis, the spleen is crucially involved in all the steps of AIHA pathobiology. Splenectomy, which was the established second-line therapeutic option in corticosteroid-resistant AIHA patients for decades, has become less common due to increasing knowledge of immunopathogenesis and the introduction of targeted therapy. This article provides a comprehensive overview of current knowledge regarding the place of the spleen in the immunological background of AIHA and the rapidly growing spectrum of novel therapeutic approaches. Furthermore, this review emphasizes the still-existing expediency of laparoscopic splenectomy with appropriate perioperative thromboprophylaxis and the prevention of infection as a safe and reliable therapeutic option in the context of the limited availability of rituximab and other novel therapies.<\/jats:p>","DOI":"10.3390\/diagnostics13182891","type":"journal-article","created":{"date-parts":[[2023,9,11]],"date-time":"2023-09-11T09:05:17Z","timestamp":1694423117000},"page":"2891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The Role of the Spleen and the Place of Splenectomy in Autoimmune Hemolytic Anemia\u2014A Review of Current Knowledge"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4428-7253","authenticated-orcid":false,"given":"Zorica","family":"Cvetkovi\u0107","sequence":"first","affiliation":[{"name":"Department of Hematology, University Hospital Medical Center Zemun, 11080 Belgrade, Serbia"},{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7798-4026","authenticated-orcid":false,"given":"Nikola","family":"Panti\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0907-7552","authenticated-orcid":false,"given":"Mirjana","family":"Cvetkovi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4626-4215","authenticated-orcid":false,"given":"Marijana","family":"Virijevi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5488-126X","authenticated-orcid":false,"given":"Nikica","family":"Sablji\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gligorije","family":"Marinkovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Hematology, University Hospital Medical Center Zemun, 11080 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6998-2116","authenticated-orcid":false,"given":"Vladimir","family":"Milosavljevi\u0107","sequence":"additional","affiliation":[{"name":"Department for HPB Surgery, University Hospital Medical Center Be\u017eanijska Kosa, 11070 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zlatko","family":"Pravdi\u0107","sequence":"additional","affiliation":[{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8807-4797","authenticated-orcid":false,"given":"Nada","family":"Suvajd\u017ei\u0107-Vukovi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8313-3754","authenticated-orcid":false,"given":"Mirjana","family":"Mitrovi\u0107","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Belgrade, 11000 Belgrade, Serbia"},{"name":"Clinic for Hematology, University Clinical Center of Serbia, 11000 Belgrade, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1056\/NEJMra2033982","article-title":"Autoimmune Hemolytic Anemias","volume":"385","author":"Berentsen","year":"2021","journal-title":"N. 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