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Updated: Sep 27, 2026
Robot-Assisted Laparoscopic Splenectomy In Children: A Case Report with Literature Review
Published on: March 27, 2026
Splenectomy for children with thalassemia
Ahmed H Al-Salem1, Zaki Nasserulla
1Division of Pediatric Surgery, Department of Surgery, Qatif Central Hospital, Qatif, Saudi Arabia. asalem56@hotmail.com
Insights
Total splenectomy significantly reduces blood transfusion needs in children with thalassemia and hypersplenism. Partial splenectomy offers temporary benefits for beta-thalassemia and may benefit Hb H disease patients.
Area of Science:
- Pediatric Hematology
- Surgical Management of Thalassemia
Background:
- Thalassemia is a group of inherited blood disorders requiring lifelong management.
- Hypersplenism is a common complication in thalassemia, leading to increased transfusion dependence.
- Splenectomy is a surgical option to manage hypersplenism in thalassemia patients.
Purpose of the Study:
- To evaluate the efficacy of total and partial splenectomy in managing children with thalassemia and hypersplenism.
- To compare the impact of different splenectomy approaches on transfusion requirements and hemoglobin levels.
Main Methods:
- Retrospective analysis of 23 children with thalassemia who underwent either total or partial splenectomy.
- Data collection included patient demographics, thalassemia type, splenectomy type, and pre- and post-operative transfusion rates and hemoglobin levels.
Main Results:
- Total splenectomy reduced mean annual transfusions from 17.8 to 10 and Hb drop from 1.8 to 0.45 g/week.
- Partial splenectomy in beta-thalassemia major patients reduced transfusions from 15.2 to 8.2 per year and Hb drop from 1.6 to 0.5 g/week, but benefits were temporary.
- Partial splenectomy in Hb H disease patients showed promising results, with two requiring no further transfusions and one experiencing reduced transfusion needs.
Conclusions:
- Total splenectomy is an effective treatment for reducing transfusion requirements in children with thalassemia and hypersplenism.
- Partial splenectomy can be a beneficial, albeit temporary, measure for beta-thalassemia major, and may be effective for Hb H disease.
- Partial splenectomy is recommended for younger children (<5 years) with beta-thalassemia.
Abstract:
Twenty-three children with thalassemia (18 with beta-thalassemia major, 3 with Hb H disease, and 2 with thalassemia intermediate) had total splenectomy (nine beta-thalassemia major patients and two thalassemia intermediate patients) or partial splenectomy (nine beta-thalassemia patients and three Hb H disease patients) as part of their management at our hospital. There were 10 males and 1 female in the total splenectomy group (mean age, 7.8 years; range, 4.5-12 years), and 4 males and 8 females in the partial splenectomy group (mean age, 6.9 years; range, 3-10 years). In all, the indication for splenectomy was hypersplenism. In the partial splenectomy group, two children with Hb H disease required no further blood transfusions. The transfusion requirements of the third patient with Hb H disease decreased from 15 to 11 transfusions per year (from 1.2 g/week Hb drop preoperatively to 0.7 g/week postoperatively), but subsequently his transfusion requirements increased as a result of an increase in the size of splenic remnant. He underwent total splenectomy 1.5 years post-partial splenectomy. For those with beta-thalassemia major who had partial splenectomy, there was a reduction in the number of blood transfusions from a preoperative mean of 15.2 transfusions per year (range, 11-22 transfusions per year) to a postoperative mean of 8.2 transfusions per year (range, 2-11 transfusions per year). Their Hb drop decreased from a preoperative mean of 1.6 g/week (range, 0.8-3.5 g/week) to a postoperative mean of 0.5 g/week (range, 0.2-0.75 g/week). Subsequently and as a result of increase in the size of splenic remnant, their transfusion requirements increased, but none of them to this point have required total splenectomy. Eleven children had total splenectomy. Their postsplenectomy transfusion requirements decreased from a preoperative mean of 17.8 transfusions per year (range, 12-23 transfusions per year) to a postoperative mean of 10 transfusions per year (range, 8-12 transfusions per year), and their Hb drop decreased from a preoperative mean of 1.8 g/week (range, 0.5-2.3 g/week) to a postoperative mean of 0.45 g/week (range, 0.3-0.65 g/week). In conclusion, total splenectomy is beneficial for children with thalassemia and hypersplenism because it reduces their transfusion requirements. Partial splenectomy may be beneficial for those with Hb H disease. However, for those with beta-thalassemia, partial splenectomy is beneficial in reducing their transfusion requirements only as a temporary measure, and it is recommended for children who are less than 5 years of age.
