Outcome of Partial Splenectomy for Hypersplenism in Children with Thalassemia

Abstract

AbstructBackground: Total splenectomy, exposes children to the high risk of overwhelming postsplenectomy infections (OPSI). To avoid these adverse consequences, partial splenectomy has long been practiced for thalasseemia in children. It has been reported that the partial splenectomy keeps the child immunologically competent, hematologically stable with minimum blood transfusion and makes their life more comfortable in comparison to total splenectomy. in both groups but it was maintained at a more static fashion in control group than case group (P = 0.114). Howell-jolly body in the partial splenectomy group disappeared almost completely at month 6, while the same inclusion body in the total splenectomy group appeared in all the children (p= 0.001). There was no postsplenectomy infection in case group while two found in control group. After partial splenectomy the residual volume of the spleen was gradually increasing. The increase in volume of the liver was notably greater in the total splenectomy group than that in the partial splenectomy group (p< 0.05).Conclusion: Partial splenectomy in patients with ²-thalassemia is effective in controlling hemolysis, improving peripheral blood picture while preserving the residual splenic phagocytic and immune function.

Partial splenectomy followed by total splenectomy in thalassemia

“…2 But for any age of thalassemic patients requiring splenectomy, partial splenectopmy leaves the option of total splenectomy open-should relapse occur. Thus, Partial splenectopmy as the initial procedure, may add some quality years to thalassemic patients of all ages before eventual total splenectomy by obviating the need for prolonged and 'difficult to follow' mandatory antibiotic prophylaxis.…”

“…1 During the six months follow-up period in a study in children with thalassemia showed favorable initial results. 2 After six years of partial splenectomy, one boy of this study group presented to us for total splenectomy, at BSMMU, again with increasing need of too much blood transfusions, secondary hypersplenism and mechanical discomfort with huge splenomegaly.…”