Clinical events after surgical splenectomy in children with sickle cell anemia

Division of Pediatric Hematology and Oncology, The Children's Mercy Hospitals and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA.
Pediatric Surgery International (Impact Factor: 1). 03/2010; 26(5):495-500. DOI: 10.1007/s00383-010-2587-4
Source: PubMed


Despite advances in immune prophylaxis, sepsis remains the most feared complication following splenectomy for acute splenic sequestration crisis (ASSC) in children with sickle cell anemia (SCA). We seek to investigate the true prevalence of sepsis and other complications of splenectomy in this patient population.
We reviewed the records of children with SCA (HbSS) who underwent splenectomy for ASSC between 1993 and 2008 at a single institution.
Fifty-eight patients (33 males) at a median age of 2 years at splenectomy were included with an average post-splenectomy follow-up of 6.4 years (range 6 months-14 years). Thirty-seven patients (64%) underwent laparoscopic splenectomy, and acute chest syndrome (ACS) was the most common post-operative complication (6.9%). There was no difference in the incidence of sepsis pre- and post-splenectomy. The occurrence of vaso-occlusive pain crises (VOC) and ACS was significantly higher after splenectomy. In addition, 14 patients (24%) developed stroke (n = 5) or an abnormal transcranial Doppler (TCD) (n = 9) after splenectomy.
Our data suggest that splenectomy can be safely performed in children with SCA given a low risk of sepsis. However, the increased incidence of VOC, ACS, and stroke or abnormal TCDs after splenectomy remains a concern.

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    • "This increased prevalence was not explained by known determinants of bone pain or chest syndrome, such as high haemoglobin or low HbF, raising the hypothesis that splenic complications, such as acute splenic sequestration, may be a predictive factor of disease severity. A higher incidence of severe complications in the pre-versus post-splenectomy period was also reported (Kalpatthi et al, 2010) in 58 children splenectomized at a median age of 2 years. However, considering the young age of these patients, a serious bias may well be the expected increasing incidence of these complications with age. "
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