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Splenectomy in thalassaemia major: experience at Madina Maternity and Children's Hospital, Saudi Arabia
Z M al Hawsawi1, T I Hummaida, G A Ismail
1Department of Paediatrics, Madina Maternity & Children's Hospital, PO Box 6205, Madina Al Munawara, Saudi Arabia. zhawsawi@yahoo.com
Insights
Splenectomy in children with thalassaemia major safely reduced transfusion needs and improved hemoglobin levels. Prophylactic penicillin was effective in preventing post-splenectomy infections when vaccines were unavailable.
Area of Science:
- Pediatric Surgery
- Hematology
Background:
- Thalassaemia major requires frequent blood transfusions.
- Splenomegaly and increased transfusion needs are common complications.
Purpose of the Study:
- To evaluate the outcomes of splenectomy in children with thalassaemia major.
- To assess the safety and efficacy of penicillin prophylaxis in the absence of vaccines.
Main Methods:
- Retrospective study of 18 children (ages 5-12) who underwent splenectomy.
- Analysis of transfusion requirements, hemoglobin levels, and complications.
- Administration of pre- and post-operative penicillin prophylaxis.
Main Results:
- Splenectomy led to a reduced transfusion requirement (from 2 to 4 weeks) and increased pre-transfusion hemoglobin (from 6 to 9 g/dl).
- No cases of post-splenectomy septicaemia or deaths were reported.
- Penicillin prophylaxis was effective in preventing serious infections.
Conclusions:
- Splenectomy is a safe and effective procedure for children over 5 years with thalassaemia major.
- Penicillin prophylaxis is a viable alternative to vaccines for preventing infections after splenectomy in this population.
Abstract:
Eighteen (32%) of 56 children with thalassaemia major, whose ages ranged from 5 to 12 years (mean 8.8), underwent splenectomy at Madina Maternity and Children's Hospital, Saudi Arabia during the period January 1992 to December 1999. This retrospective study was undertaken with the aim of discovering the outcome. The indications for splenectomy were increased transfusion requirements and massive splenomegaly in 17 children and splenic abscess in one. Polyvalent pneumococcal and Haemophilus influenza vaccines were not available and all the children therefore received intramuscular benzathine penicillin prophylaxis prior to surgery and oral penicillin prophylactically afterwards. Post-splenectomy septicaemia did not occur. The mean transfusion requirement reduced from 2 to 4 weeks and the mean pre-transfusion haemoglobin rose from 6 to 9 g/dl. There were no deaths. We conclude that splenectomy can be performed safely in children over 5 years of age with thalassaemia, and that pre- and post-operative penicillin can be given prophylactically in the absence of the recommended vaccines.