Haematological parameters in sickle cell anaemia patients with and without splenomegaly

The aim is to investigate the clinical and haematologic effects of persistent splenomegaly (PS) and splenectomy in a population of Nigerians with sickle cell anaemia (SCA).

SCA patients attending the Haematology clinic of the OAUTHC, Ile-Ife, were examined physically and haematologically. Patients with PS were compared with age and sex-matched controls without splenomegaly. Foetal haemoglobin (HbF), packed cell volume (PCV), reticulocyte count and the frequency of blood transfusion were noted for both groups. The clinical effects of splenectomy were documented in three patients who underwent the procedure because of symptomatic massive splenomegaly (> or = 10 cm).

Seventy-one patients, 40 males and 31 females, aged 16-48 (median, 21) years were studied. Nineteen (26.8%) had PS ranging from 3-22 cm (mean +/- SD = 9.4 +/- 4.4 cm; median = 7 cm). Ten of these had massive splenomegaly (spleen > or = 10 cm) varying from 10-22 cm (mean +/- SD = 12.3 +/- 3.8 cm; median = 12 cm). No significant differences were found between the mean values of HbF, PCV, reticulocyte count, frequencies of pain crisis, transfusion requirement, weights and heights in SCA with PS and age-sex matched controls without PS. Annual transfusion requirement showed a mild negative correlation with splenic size (r = -0.06), which was not statistically significant (p = 0.882). Significant haematologic improvement was confirmed in the 3 patients who underwent elective splenectomy for splenomegaly-induced hypersplenism.

We conclude that massive persistent splenomegaly is a recognised cause of significant morbidity in SCA patients as evident in the patients that underwent splenectomy. However, where it is mild to moderate, PS may not have significant adverse effect on the overall clinical picture of the disorder.