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Title: Splenectomy Reduces Packed Red Cell Transfusion Requirement in Children with Sickle Cell Anaemia: Presented at AAP

"Splenectomy Reduces Packed Red Cell Transfusion Requirement in Children with Sickle Cell Anaemia: Presented at AAP"

By Nora Steiner Mealy SAN FRANCISCO, CA -- October 29, 2007 -- In children with sickle cell anaemia, splenectomy significantly reduces the need for packed red cell transfusion, according to findings presented here at the American Academy of Pediatrics National Conference and Exhibition (AAP). Ramanth N. Haricharan, MBBS, MPH, Assistant Professor of Surgery, Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama, United States, reported on 37 children who underwent splenectomy between January 2000 and May 2006 at a tertiary care children's hospital. The study enrolled children on chronic transfusions with hypersplenism or who had multiple sequestration episodes. Spleen size by itself was not a criterion. Laparoscopic splenectomy was attempted in 36 of the children and was successfully completed in 34 (94%). Data could be analysed in 34 of the children. Their median age was 11 years (range, 2-18 years). Twenty-six children had haemoglobin (Hgb) SS, five had Hgb-SC, and three had sickle beta thalassaemia (hgb S/Thal). Compared with data gathered 6 months the splenectomy procedure, the number of transfused units was reduced by 38% in the first 6 months after the procedure ([P <.0001) and by 45% 6 to 12 months after the procedure (P <.001 respectively).

In addition, haematocrit levels significantly increased and reticulocyte counts decreased postoperatively. Transfusion visits also were significantly reduced.

"Splenectomy had a dramatic effect on packed cell transfusion requirements," said Dr. Haricharan.

The decrease in transfusion requirement was not influenced by spleen weight, the patient's age, or the patient's haemoglobin type. In the follow-up period, two children (6%) had acute chest syndrome and one (3%) had severe pneumonia.

No cases of postsplenectomy sepsis occurred. Dr. Haricharan also noted that even children with smaller than expected spleen sizes at the time of the procedure had benefit from the splenectomy, leading him to speculate that they still had some splenic function.

"In select patients with sickle cell disease, splenectomy can be successfully completed laparoscopically, and reduces the transfusion requirement of packed cell units," commented principal investigator Douglas C. Barnhart, MD, MSPH at the presentation, who is also of the Division of Pediatric Surgery at the University of Alabama at Birmingham.

[Presentation title: Splenectomy Reduces Packed Red Cell Transfusion Requirement in Children with Sickle Cell Anemia. Abstract 504]

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