SPLENECTOMY IN PATIENTS WITH SICKLE-CELL DISEASE

BACKGROUND: Splenic complications of sickle-cell disease (SCD) are ass ociated with morbidity, and in some it may lead to mortality. This pap er presents our experience with 43 patients with SCD who had splenecto my as part of their management. PATIENTS AND METHODS: The records of 4 3 patients with SCD who had splenectomy were examined for age at opera tion, sex, hemoglobin (Hb) electrophoresis, indication for splenectomy , pre- and postoperative medications, operative procedures, and postop erative complications. RESULTS: The indications for splenectomy were a cute splenic sequestration crisis (ASSC) in 21 patients, hypersplenism in 15, and splenic abscess in 7. In 17 patients, the spleen was also found to be massively enlarged causing discomfort and intervening with everyday activity. For those with hypersplenism, there was a signific ant postoperative increase in total Hb (P <0.0001), hematocrit (P <0.0 001), white blood cells (P <0.0001), and platelet count (P <0.0001). C ONCLUSIONS: With careful perioperative management and proper follow-up , splenectomy in patients with SCD is beneficial in reducing their tra nsfusion requirements and its attendant risks, eliminating the discomf ort from mechanical pressure of the enlarged spleen, avoiding the risk s of ASSC, and managing splenic abscess.