Partial splenic embolization in a child with hereditary spherocytosis

Abstract

Partial splenic embolization (PSE) was introduced as an alternative to splenectomy to avoid the risk of post-splenectomy sepsis and to reduce the number of situations in which surgery would be dangerous or not feasible [5]. PSE is an accepted therapy for the treatment of secondary hypersplenism in various disorders, including oesophageal variceal haemorrhage [3] As an alternative to surgical splenectomy, PSE was performed on a 7-year-old girl with hereditary spherocytosis and hypersplenism who initially presented with a haemolytic crisis; haemoglobin values of 6.8 g/dl, jaundice and splenomegaly. She needed blood transfusions on two occasions due to persistent anaemia, with Hb values between 6.8-9 g/dl. PSE was performed following the Spigos protocol [8].Peripheral blood cell counts were repeated on days 1, 3, 7 and 15, and then 1, 3, 6, and 12 months after PSE (see Table 1). Abdominal ultrasound 1 month after PSE showed a 17% reduction in spleen size, with embolization of approximately 75% of the spleen.Maddison [7] performed the first successful splenic arterial embolization in 1973. The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al. [5] recently reported a lower rate of complications using polyvinyl alcohol.The increase in haemoglobin values found in our patient has been observed in patients affected by other diseases who have required PSE [5]. The thrombocytosis observed in our patient during the first 15 days after PSE that returned to normal values over 3 months, has been previously reported [3,5]. This increase in platelet count appears to be