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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease
Ramanath N Haricharan1, Jared M Roberts, Traci L Morgan
1Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Insights
Splenectomy significantly reduces the need for blood transfusions in children with sickle cell disease. This procedure also decreases clinic visits for at least 12 months post-surgery.
Area of Science:
- Pediatric Hematology
- Surgical Oncology
Background:
- Sickle cell disease (SCD) is a genetic blood disorder requiring frequent medical interventions.
- Packed red blood cell transfusions are a common management strategy for SCD complications.
- Splenectomy is a surgical option considered for certain SCD-related issues.
Purpose of the Study:
- To evaluate the impact of splenectomy on the requirement for packed red blood cell transfusions in pediatric patients with sickle cell disease.
- To assess changes in transfusion needs and clinic visit frequency following splenectomy.
Main Methods:
- Retrospective review of 37 children with sickle cell disease who underwent splenectomy between 2000 and 2006.
- Data collection included transfusion records from 6 months preoperatively to 12 months postoperatively.
- Statistical analyses included paired t tests, ANOVA, and multivariable regression.
Main Results:
- Laparoscopic splenectomy was successfully completed in 34 of 36 attempted cases (94% success rate).
- The number of transfused units decreased by 38% (0-6 months) and 45% (6-12 months) post-splenectomy.
- Postoperative improvements included increased hematocrit, decreased reticulocytes, and fewer transfusion clinic visits, independent of spleen weight, age, or hemoglobin type.
Conclusions:
- Laparoscopic splenectomy is a safe and effective procedure in children with sickle cell disease.
- Splenectomy leads to a significant reduction in packed red blood cell transfusion requirements for at least 12 months postoperatively.
- The procedure also decreases the frequency of clinic visits for managing transfusion needs in pediatric SCD patients.
Purpose:
The purpose of the study was to measure the effect of splenectomy on packed-cell transfusion requirement in children with sickle cell disease.
Methods:
Thirty-seven sickle cell children who underwent splenectomies between January 2000 and May 2006 at a children's hospital were reviewed. Data were collected 6 months preoperatively to 12 months postsplenectomy. Paired t test, analysis of variance, and multivariable regression analyses were performed.
Results:
Of 37 children with median age 11 years (range, 2-18 years), 34 (21 males) had data that allowed analyses. Twenty-six had Hgb-SS, 5 had Hgb-SC, and 3 had Hgb S-Thal. Laparoscopic splenectomy was attempted in 36 and completed successfully in 34 (94% success). The number of units transfused decreased by 38% for 0 to 6 months and by 45% for 6 to 12 months postsplenectomy. Postoperatively, hematocrit levels increased and reticulocytes concurrently decreased with a reduction in transfusion clinic visits. The decrease in transfusion was not influenced by spleen weight, age, or hemoglobin type. Two children had acute chest syndrome (6%), and 1 had severe pneumonia (3%).
Conclusion:
Laparoscopic splenectomy can be successfully completed in sickle cell children. Splenectomy significantly reduces the packed red cell transfusion requirement and frequency of clinic visits, in sickle cell children for at least 12 months postoperatively.
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