Our Summary

This research looks at the outcomes of a surgical procedure called open splenectomy (removal of the spleen), performed together with a selective blood transfusion, on Jamaican children with sickle cell disease. The data collected from 150 surgeries between 1994 and 2017 showed no deaths. The average hospital stay after surgery was around three days.

The selective blood transfusion method used in this study aimed to bring the patients’ haemoglobin levels (the protein in red blood cells that carries oxygen) to about 100 g/L if their levels were 10 g/L below normal when admitted.

There were complications in around 13% of cases, with over half of these being acute chest syndrome, a serious lung-related complication of sickle cell disease. This was less common in patients who received transfusions, suggesting that the transfusion protocol could be useful, especially in hospitals with low blood supplies.

FAQs

  1. What is the purpose of a selective blood transfusion in an open splenectomy for children with sickle cell disease?
  2. What were the common complications observed in the study of open splenectomies in Jamaican children with sickle cell disease?
  3. What was the average hospital stay for children who underwent an open splenectomy?

Doctor’s Tip

A doctor might tell a patient undergoing a splenectomy that it is important to follow post-operative instructions carefully, including taking prescribed medications, avoiding strenuous activities, and watching for signs of infection. They may also advise the patient to get vaccinated against certain infections, as the spleen plays a role in the immune system and its removal can increase the risk of certain infections. Additionally, the doctor may recommend regular follow-up appointments to monitor the patient’s overall health and well-being after the surgery.

Suitable For

Patients who are typically recommended splenectomy include those with sickle cell disease who have recurrent episodes of acute splenic sequestration crisis or have a significantly enlarged spleen that is causing pain or other complications. Other conditions that may warrant splenectomy include hereditary spherocytosis, autoimmune hemolytic anemia, and certain types of cancers such as Hodgkin’s lymphoma. Additionally, patients with a ruptured spleen due to trauma or other causes may also require splenectomy.

Timeline

Before splenectomy:

  • Patient with sickle cell disease experiences symptoms such as anemia, fatigue, pain crises, and susceptibility to infections due to spleen dysfunction
  • Patient undergoes preoperative assessments and consultations with healthcare providers
  • Patient may receive preoperative blood transfusions to improve hemoglobin levels
  • Patient undergoes open splenectomy surgery

After splenectomy:

  • Patient stays in the hospital for an average of three days post-surgery
  • Patient may receive selective blood transfusions to maintain hemoglobin levels
  • Patient may experience complications such as acute chest syndrome, which can be managed with appropriate treatment
  • Patient is monitored closely for any signs of infection or other complications
  • Patient may have a reduced risk of infections due to improved spleen function post-splenectomy

What to Ask Your Doctor

  1. What are the potential risks and complications associated with splenectomy for patients with sickle cell disease?
  2. How will my post-operative care plan be different due to my sickle cell disease?
  3. Will I need to undergo any special testing or monitoring after the splenectomy?
  4. How will my immune system be affected by the removal of my spleen, and what steps can I take to prevent infections?
  5. How will the selective blood transfusion method be used in my treatment plan, and what are the potential benefits and risks?
  6. How will the surgery and recovery process be different for me compared to patients without sickle cell disease?
  7. Are there any specific lifestyle changes or precautions I should take following the splenectomy?
  8. Are there any long-term implications or considerations I should be aware of after undergoing splenectomy for sickle cell disease?

Reference

Authors: Steele O, Duncan AL, Simms LN, Duncan SA, Byles SED, Duncan ND. Journal: Trop Doct. 2021 Apr;51(2):150-155. doi: 10.1177/0049475520974619. Epub 2020 Nov 26. PMID: 33241734