Septic complications after splenectomy for sickle cell sequestration crisis

Abstract

Patients with sickle cell disease (SCD) are predisposed to infections. There is a paucity of recent information on the incidence of post-splenectomy infectious complications in these patients. The purpose of this study was to determine whether splenectomy increases infectious complications in SCD. Twenty-nine patients with SCD had splenectomy for sequestration crises at our hospital between 1988 and 1992; 16 of them received all of their follow-up care at our institution. These 16 charts were reviewed for infectious-related admissions, hospital days, days of i.v. antibiotics, positive cultures, and episodes of sepsis. For each patient, these parameters in the pre- and postoperative period were compared and expressed as number per year. The mean age at time of splenectomy was 2.5 +/- 0.4 years and the mean follow-up was 4.5 +/- 0.4 years. There was no significant difference in the pre- and postoperative periods for admissions, hospital days, days of i.v. antibiotics, positive cultures, or episodes of sepsis per year. There were also no operative deaths. The incidence of pre-splenectomy sepsis was 0.04 +/- 0.03 episodes per year compared to 0.09 +/- 0.04 (P = ns) episodes/year after splenectomy. Sepsis occurred at an average of 20.8 (range 2-30) months postoperatively; Streptococcus pneumoniae was the most common causative organism. The total mortality after splenectomy in SCD patients was 3.4% (1/29) over a nearly 5-year period. Although infections are common in children with SCD, there was no increase in infections or episodes of sepsis in SCD patients who underwent splenectomy.

Complicações infecciosas em crianças com doença falciforme após esplenectomia cirúrgica

“…A case series study of sickle-cell patients splenectomized from 1988 to 1992 showed no statistical difference in the incidence of sepsis before and after splenectomy, 16 a result similar to that observed by Kalpatthi et al., who performed a retrospective cohort study of 58 patients and also found no difference in the risk of invasive infections before and after surgery. 17 The risk of invasive infection, especially pneumococcal, in children with sickle-cell disease is the highest in the first 3 years of life and significantly decreases after the age of 5.…”

Outcome of splenectomy in children younger than 4 years with sickle cell disease

“…However, only 16% of these children received immunization against H influenzae and pneumococcus, and none received the N meningitidis vaccine. Another study of 29 patients observed for 4 years demonstrated no significant difference in number of sepsis episodes per year before and after splenectomy performed around the second birthday [15]. This study used penicillin prophylaxis and preoperative Pneumovax vaccination.…”

Splenectomy in sickle cell haemoglobinopathies

“…As a means to prevent future acute splenic sequestration crisis, elective splenectomy has been indicated in children older than 2 or 3 years of age after the first episode of the crisis. 10,11 Hypersplenism is defined as a clinical syndrome characterised by splenic enlargement, any combination of anaemia, leukopenia or thrombocytopenia, compensatory bone marrow hyperplasia and improvement after splenectomy. The patients become transfusion dependent to maintain haemoglobin level.…”