Nasim ul Majid, Farooq Dar, Muhammad Arshad.
Effects of Splenectomy in the management of Thalassemia Major.
Pak Armed Forces Med J Nov ;50(2):71-5.

Patients with thalassemia major commonly develop hypersplenism after 5-10 years of regular blood transfusions. As a result of splenic enlargement transfusion requirement steadily increase, accelerating the influx of toxic iron. Splenectomy is one form of the management of thalassemia disease. 40 patients with B-thalassemia who were followed for atleast 2-1/2 years before and after splenectomy were studied retrospectively for the result of splenectomy. These patients were on regular blood transfusion when they had their splenectomy and the mean blood transfusion requirement dropped from 315 ml/kg/year of packed red cells to 230 ml following splenectomy and the mean hemoglobin rose from 6.7 gm/dl to 8.5 gm/dl. The result of the follow up study of these patients showed sepsis to be the main complication. 4 patients died during the follow up and 2 were below the age of 6 years. These results suggest that splenectomy in B-thalassemia produces an improvement in the quality of life of the patient and decreases the medical expenses. To reduce the development of hypersplenism and splenomegaly in these patients, pre-splenectomy transfusion efficiency must be improved which may postpone the need of splenectomy until the immunological response reaches adult level and to avoid septic complication after splenectomy, patients must be followed by vaccination and prophylactic antibiotic therapy.

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