title: Post Splenectomy Outcome in β-Thalassemia.
abstract: OBJECTIVE
  To evaluate changes in annual blood transfusion requirements and complications after splenectomy in patients with β-thalassemia.
  
  
  METHODS
  Forty post-splenectomy β-thalassemic patients aged 8-33 y, receiving regular blood transfusions and chelation therapy were included and non transfusion dependant patients were excluded from this retrospective cross-sectional study. Details about their surgery, transfusion requirements, and platelet levels were recorded on a standard proforma. All patients underwent a B-mode and color-coded duplex sonography of the hepatoportal system during the study period.
  
  
  RESULTS
  The average ferritin level in the year prior to the study was 4432 mcg/L (range 480-12,200 mcg/L). The annual blood transfusion requirement in the first year and 5 y post splenectomy [mean ± SD (138.41 ± 90.38 ml/kg/y); (116 ± 41.44 ml/kg/y)] were significantly different from requirements before splenectomy [(mean ± SD) 294.85 ± 226 ml/kg/y; p value <0.001]. There was a significant rise in platelet counts within 24 h post splenectomy with a mean rise of 4,51,000/mm(3) (p value < 0.001). During the follow up period, infections were noted in 50 % of patients, with malaria (18.75 %) being the most common. Doppler study of the portal system in one case showed portal vein thrombosis.
  
  
  CONCLUSIONS
  A significant sustained fall in annual blood transfusion requirement and a rise in platelet counts occurred post-splenectomy. Increase in annual blood transfusion requirement should be investigated to find the cause.
authors.affiliation: Department of Pediatrics, Nanavati Super Speciality Hospital, Vile Parle (W), Mumbai, 400056, Maharashtra, India. deandoc2000@hotmail.com.
authors.forename: Rashid H
authors.initials: RH
authors.lastname: Merchant
authors.affiliation: Department of Pediatrics, Nanavati Super Speciality Hospital, Vile Parle (W), Mumbai, 400056, Maharashtra, India.
authors.forename: Ami R
authors.initials: AR
authors.lastname: Shah
authors.affiliation: Department of Pediatrics, Nanavati Super Speciality Hospital, Vile Parle (W), Mumbai, 400056, Maharashtra, India.
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmad
authors.affiliation: Department of Radiology, Nanavati Super Speciality Hospital, Mumbai, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Karnik
authors.affiliation: Department of Pediatrics, New York Methodist Hospital, New York, NY, USA.
authors.forename: Nooralam
authors.initials: N
authors.lastname: Rai
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion / Q000379:methods / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D017063:Outcome Assessment, Health Care; D010976:Platelet Count / Q000379:methods*; D011168:Portal System / Q000000981:diagnostic imaging*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D018616:Ultrasonography, Doppler, Duplex / Q000379:methods / Q000706:statistics & numerical data; D017086:beta-Thalassemia / Q000453:epidemiology / Q000601:surgery
keywords: Complications; Post-splenectomy; Splenunculi; Thalassemia; Transfusion requirements