Splenectomy reduces packed red cell transfusion requirement in children with sickle cell disease.
OBJECTIVE
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%).


CONCLUSIONS
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.
Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Ramanath N
RN
Haricharan
Jared M
JM
Roberts
Traci L
TL
Morgan
Charles J
CJ
Aprahamian
William D
WD
Hardin
Lee M
LM
Hilliard
Keith E
KE
Georgeson
Douglas C
DC
Barnhart
D000293:Adolescent; D000367:Age Factors; D000704:Analysis of Variance; D000755:Anemia, Sickle Cell / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D011182:Postoperative Care / Q000379:methods; D011788:Quality of Life; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013156:Splenectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome