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Comparative Study
. 2007 Oct;50(5):382-6.

Prevention of overwhelming postsplenectomy infection in thalassemia patients by partial rather than total splenectomy

Anwar K Sheikha  1 , Ziyan T Salih, Kalandar H Kasnazan, Mohammad K Khoshnaw, Talal Al-Maliki, Tarek A Al-Azraqi, Mubarak H Zafer
Affiliations
Free PMC article
Comparative Study

Prevention of overwhelming postsplenectomy infection in thalassemia patients by partial rather than total splenectomy

Anwar K Sheikha et al. Can J Surg. 2007 Oct.
Free PMC article

Abstract
in English, French

Objective: We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure.

Methods: In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication.

Results: A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years.

Conclusions: Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.

Objectif: Nous voulions évaluer le rôle de la splénectomie partielle par rapport à la splénectomie totale comme mesure de protection contre la septicémie chez les patients atteints de thalassémie lorsque d'autres mesures préventives ne sont pas disponibles. L'infection postsplénectomie irrépressible est une complication grave de la splénectomie chez ces patients et elle est conjuguée le plus souvent à une septicémie à pneumocoque. Le vaccin antipneumococcique administré avant l'intervention chirurgicale est une mesure préventive bien établie.

Méthodes: Au cours de cette étude, nous avons comparé deux populations de patients de l'Irak et de l'Arabie saoudite qui ont tous subi une splénectomie à cause d'une thalassémie. Tous les patients de l'Arabie saoudite ont reçu un vaccin antipneumococcique préopératoire et ont subi une splénectomie totale après environ quatre semaines. Malheureusement, le vaccin n'était pas disponible pour les patients irakiens. On a offert une splénectomie partielle à beaucoup de ces patients comme mesure de protection contre cette complication mortelle.

Résultats: On a constaté une différence importante entre les splénectomies totales mortelles chez les deux groupes. On a enregistré cinq décès chez les 30 patients irakiens inscrits en quatre ans. On a signalé un décès en 12 ans chez les 22 patients de l'Arabie saoudite. On a établi un lien entre la splénectomie partielle et une réduction spectaculaire du taux de mortalité chez les patients irakiens. Aucun des 12 patients n'est mort au cours d'une période de suivi de quatre ans.

Conclusions: Le pneumovax est un outil prophylactique puissant contre l'infection postsplénectomie irrépressible chez les patients atteints de thalassémie et il faudrait l'utiliser chaque fois qu'il est disponible. Dans les pays pauvres ou ceux où les ressources sanitaires limitées posent des problèmes, la splénectomie partielle plutôt que totale pourrait offrir une solution de rechange afin d'éviter cette complication mortelle.

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Figures

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FIG. 1. Age group distribution (%) of patients who underwent splenectomy for thalassemia.
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