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Clinical and hematologic benefits of partial splenectomy for congenital hemolytic anemias in children. Ann Surg 2003 Feb;237(2):281-8 PMID: 12560788 PMCID: PMC1522140

Pubmed ID

12560788

Abstract

OBJECTIVE: To assess the role of partial splenectomy for symptomatic children with various congenital hemolytic anemias.

SUMMARY BACKGROUND DATA: The use of total splenectomy for symptomatic children with congenital hemolytic anemias is restricted by concern of postsplenectomy sepsis. A partial splenectomy is an alternative procedure, although its utility remains incompletely defined.

METHODS: This longitudinal cohort study followed 25 symptomatic children with various congenital anemias who underwent partial splenectomy. Sixteen children had hereditary spherocytosis (HS), and nine children had other erythrocyte disorders. Outcome measures were clinical and laboratory hemolysis, splenic phagocytic and immune function, and splenic regrowth as measured by ultrasonography. Discrete parameters were compared using the Student test.

RESULTS: Partial splenectomy was successful in all 25 children, with minimal morbidity. Follow-up ranged from 7 months to 6 years (mean 2.3 +/- 1.5 years). Following surgery, children with HS had increased hemoglobin values, decreased reticulocyte and bilirubin levels, and preserved splenic function. Most children without HS had decreased symptoms of hypersplenism and splenic sequestration. Over time, variable rates of splenic regrowth were noted, although regrowth did not necessarily correlate with recurrent hemolysis.

CONCLUSIONS: In children with hereditary spherocytosis, a partial splenectomy appears to control hemolysis while retaining splenic function. In children with other congenital hemolytic anemias, a partial splenectomy appears to control symptoms of hypersplenism and splenic sequestration.

Author List

Rice HE, Oldham KT, Hillery CA, Skinner MA, O'Hara SM, Ware RE

Author

Keith T. Oldham MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-85047693774   74 Citations

MESH terms used to index this publication - Major topics in bold

Adolescent
Anemia, Hemolytic, Congenital
Child
Child, Preschool
Cohort Studies
Hematologic Tests
Hemolysis
Humans
Immunologic Tests
Infant
Longitudinal Studies
Phagocytosis
Regeneration
Spleen
Splenectomy
Treatment Outcome
jenkins-FCD Prod-310 bff9d975ec7f2d302586822146c2801dd4449aad