Splenectomy in thalassemia

ABSTRACT

The aims of our study were to illustrate the most common indications for splenectomy in patients with beta thalassemia and to clarify the effect of splenectomy on blood transfusion requirements in our patients. This is a retrospective study of 36 patients with B thalassemia who underwent splenectomy in Prince Rashed Ben Al-Hassan Hospital in Irbid in the northern area of Jordan over a period of 10 years, from January 1993 to January 2003. Case histories were reviewed with regard to age, sex, indication for splenectomy, blood transfusion requirements [both amount and frequency], hematocrit level [pre and post splenectomy], hepatitis C virus [HCV] antibodies, preparations made for surgery, and post-operative complications. Increased transfusion requirements, hypersplenism, and massive splenomegaly were the most common indications for splenectomy in beta thalassemia patients. For 6-12 preoperative months, the frequency of blood transfusion had increased from nearly monthly intervals [10-12 times per year] up to more than 20 to 24 times per year. The amount of blood required had increased from a mean of 150 cc /kg/year to more than a mean of 280cc/kg/year during the same period of preoperative time. Post splenectomy, patients with beta thalassemia major returned to a monthly transfusion regimen [15-28 months, mean 21.5 months]. In patients with beta thalassemia intermedia, the effect of splenectomy was longer lasting [36-48 months, mean 42 months]. Hepatitis C infection was seen in 20 beta thalassemia patients [56%] before splenectomy. Splenectomy is beneficial for children with beta thalassemia and hypersplenism because it reduces blood transfusion requirements even if only for a temporary period. Polyvalent vaccines should be given to all patients before splenectomy to reduce complications