title: Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  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.Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy.Date of the most recent search: 06 December 2012.
  
  
  METHODS
  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.
  
  
  METHODS
  No trials of splenectomy for acute splenic sequestration were found.
  
  
  RESULTS
  No trials of splenectomy for acute splenic sequestration were found.
  
  
  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.
authors.affiliation: Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana. sowusu_ofori@hotmail.com.
authors.forename: Shirley
authors.initials: S
authors.lastname: Owusu-Ofori
authors.forename: Ceri
authors.initials: C
authors.lastname: Hirst
mesh_terms: D000208:Acute Disease; D000755:Anemia, Sickle Cell / Q000150:complications*; D001803:Blood Transfusion; D006801:Humans; D013156:Splenectomy; D013158:Splenic Diseases / Q000601:surgery / Q000628:therapy*