COMPLICATIONS FOLLOWING SPLENECTOMY IN BE NIGN HEMATOLOGICAL DISEASE IN CHILDREN AND ADOLESCENTS

Background: Splenectomy is frequently required for children suffering from hereditary spherocytosis, homozygous beta-thalassemia and idiopat hic thrombocytopenic purpura. However, serious infections, thromboembo lisms and other complications are major risks following splenectomy. I n order to ascertain the clinical importance of these complications we determined the frequency of severe infections, thromboembolic events as well as other postsplenectomy complications in splenectomized child ren and adolescents with benign hematological diseases. Patients' data : The medical records of 73 splenectomized children and adolescents (a ge 8 months to 18 years; 1970-1991, were evaluated: 38 of them had a c ongenital hemolytic anemia, 25 a thalassemia major or intermedia, 3 an ITP, and 7 other hematological diseases. Patients suffering from onco logical diseases or traumatic splenic rupture were excluded from the s tudy. At the time of splenectomy, 15 children were younger than 5 year s old, 58 children were older. All received a penicillin prophylaxis f or at least two years after splenectomy. Since 1978 all patients were vaccinated against streptococcus pneumoniae before splenectomy. Result s: Altogether 18 severe complications occured within some days or up t o 8 years after splenectomy in 14 (19%) of the 73 patients: sepsis, pn eumonia and other bacterial infections, portal and mesenteric vein thr omboses, deep leg vein thrombosis, hemorrhages and ileus. Sepsis, pneu monia and other severe infections were observed in 9 of those 14 patie nts. In no case pneumococcus was identified. Two patients died from ex tensive portal and mesenteric vein thromboses, one patient from a fulm inant interstitial pneumonia. Patients splenectomized before the age o f five years had an increased risk of acquiring serious postsplenectom y infections: three children, splenectomized before the age of five ye ars, developed sepsis or a severe, lethal pneumonia whereas older chil dren did not have sepsis or other lethal infections. Conclusion: Despi te penicillin prophylaxis and pneumococcal vaccination, sepsis and oth er severe infections (partly with atypical pathogens) may occur among splenectomized patients. Considering the high frequency of postoperati ve complications the indication for splenectomy should be weighed care fully. Children should not be splenectomized before they reach the age of 5 years. Platelet aggregation-inhibitors should be given prophylac tically if platelets rise over 500.000/mm(3) after surgery.