Splenectomy in children with sickle cell disease and thalassemia

A number of Saudi children (31) with sickle cell disease and thalassemia underwent splenectomy : 12 for frequent blood transfusions, 15 for chronic hypersplenism (most of whom were also the recipients of periodic blood transfusion) and 4 for splenic abscess. The mean age of splenectomy was 8.8 years (8 months 3–18 years). Eight patients had sickle cell disease, 14 betathalassemia and 9 had sickle cell thalassemia. All patients received prophylaxis against pneumococcal infection. There was one postoperative death most probably due to sepsis. Sixteen of those who required frequent preoperative blood transfusions needed no more transfusions, while in 7 the need for transfusions decreased significantly (p < 0.05). For those with hypersplenism, there was a significant postoperative increase in total hemoglobin (P < 0.001), RBC (P < 0.001) and platelet counts (p < 0.02); and a substantial decrease in reticulocyte counts (p < 0.05). The common post splenectomy complications were chest infection and a brief episode of pyrexia, but without undue morbidity. The study establishes a definite place for splenectomy in a selected population of children with sickle cell disease and thalassemia. Presented at the 9th Congress of the Asian Association of Pediatric Surgeons, April 6–10, 1988, Singapore.