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Splenectomy in patients with sickle-cell disease
A H al-Salem1, S Qaisaruddin, Z Nasserallah
1Department of Surgery, Qatif Central Hospital, Saudi Arabia.
Insights
Splenectomy is a beneficial treatment for sickle-cell disease (SCD) complications like splenic sequestration crisis and abscess. Careful management reduces transfusion needs and risks associated with an enlarged spleen.
Area of Science:
- Hematology
- Surgical Management
- Sickle Cell Disease
Background:
- Splenic complications in sickle-cell disease (SCD) can lead to significant morbidity and mortality.
- This study details the experience with 43 SCD patients undergoing splenectomy.
Purpose of the Study:
- To evaluate the outcomes of splenectomy in patients with sickle-cell disease.
- To assess the benefits and risks of splenectomy for various splenic complications in SCD.
Main Methods:
- Retrospective review of 43 patients with SCD who underwent splenectomy.
- Data collected included age, sex, hemoglobin electrophoresis, indications for surgery, medications, procedures, and complications.
Main Results:
- Indications for splenectomy: 21 for acute splenic sequestration crisis (ASSC), 15 for hypersplenism, 7 for splenic abscess.
- 17 patients had massively enlarged spleens causing discomfort.
- Hypersplenism cases showed significant postoperative increases in Hb, hematocrit, WBC, and platelets (P < 0.0001).
Conclusions:
- Splenectomy, with careful perioperative management, is beneficial for SCD patients.
- It reduces transfusion needs, alleviates discomfort from enlarged spleens, prevents ASSC, and manages splenic abscess.
Background:
Splenic complications of sickle-cell disease (SCD) are associated with morbidity, and in some it may lead to mortality. This paper presents our experience with 43 patients with SCD who had splenectomy as part of their management.
Patients And Methods:
The records of 43 patients with SCD who had splenectomy were examined for age at operation, sex, hemoglobin (Hb) electrophoresis, indication for splenectomy, pre- and postoperative medications, operative procedures, and postoperative complications.
Results:
The indications for splenectomy were acute splenic sequestration crisis (ASSC) in 21 patients, hypersplenism in 15, and splenic abscess in 7. In 17 patients, the spleen was also found to be massively enlarged causing discomfort and intervening with everyday activity. For those with hypersplenism, there was a significant postoperative increase in total Hb (P < 0.0001), hematocrit (P < 0.0001), white blood cells (P < 0.0001), and platelet count (P < 0.0001).
Conclusions:
With careful perioperative management and proper follow-up, splenectomy in patients with SCD is beneficial in reducing their transfusion requirements and its attendant risks, eliminating the discomfort from mechanical pressure of the enlarged spleen, avoiding the risks of ASSC, and managing splenic abscess.