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Published on: March 14, 2017
Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease
Shirley Owusu-Ofori1, Tracey Remmington
1Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, P.O.Box 1934, Kumasi, Ghana.
Insights
No trials were found comparing splenectomy to blood transfusions for preventing acute splenic sequestration crises in sickle cell disease. More research is needed to determine if splenectomy improves survival and reduces illness.
Area of Science:
- Hematology
- Pediatric Medicine
- Surgical Oncology
Background:
- Acute splenic sequestration crises are a serious complication of sickle cell disease.
- These crises have high mortality rates and frequently recur in survivors.
- Splenectomy and blood transfusions are common management strategies worldwide.
Purpose of the Study:
- To evaluate if splenectomy (total or partial) improves survival and reduces morbidity in sickle cell disease patients experiencing acute splenic sequestration crises.
- To compare splenectomy outcomes against regular blood transfusions for preventing crisis recurrence.
Main Methods:
- Searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register.
- Included randomized or quasi-randomized controlled trials comparing splenectomy to no treatment or blood transfusions.
- Most recent search conducted on August 14, 2017.
Main Results:
- No randomized controlled trials were identified that met the selection criteria.
- The review found no trials evaluating splenectomy for acute splenic sequestration crises.
Conclusions:
- There is a lack of evidence from trials demonstrating that splenectomy improves survival or decreases morbidity in sickle cell disease.
- A well-designed, adequately-powered randomized controlled trial is needed to assess the benefits and risks of splenectomy versus transfusion programs.
- No relevant trials were identified up to August 2017.
Background:
Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long-term management used in different parts of the world. This is a 2017 update of a Cochrane Review first published in 2002, and previously updated, most recently in 2015.
Objectives:
To assess whether splenectomy (total or partial), to prevent acute splenic sequestration crises in people with sickle cell disease, improved survival and decreased morbidity in people with sickle cell disease, as compared with regular blood transfusions.
Search Methods:
We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises of references identified from comprehensive electronic database searches and handsearching relevant journals and abstract books of conference proceedings. We also searched clinical trial registries. Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy.Date of the most recent search: 14 August 2017.
Selection Criteria:
All randomized or quasi-randomized controlled trials comparing splenectomy (total or partial) to prevent recurrence of acute splenic sequestration crises with no treatment or blood transfusions in people with sickle cell disease.
Data Collection And Analysis:
No trials of splenectomy for acute splenic sequestration were found.
Main Results:
No trials of splenectomy for acute splenic sequestration were found.
Authors' Conclusions:
Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in people with sickle cell disease. There is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes, as a means of improving survival and decreasing mortality from acute splenic sequestration in people with sickle cell disease.There are no trials included in the review and we have not identified any relevant trials up to August 2017. We will continue to run searches to identify any potentially relevant trials; however, we do not plan to update other sections of the review until new trials are published.
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