[Prophylactic splenectomy to prevent complications of splenomegaly in children with sickle cell anemia?]

Abstract

Objective: To assess the effects of splenectomy in children with sickle cell anemia and to propose a therapeutic approach to splenomegaly in sickle cell anemia.

Material and method: This retrospective study, conducted in the pediatric surgery department of the Tokoin Teaching Hospital in Lomé, included 8 children followed for sickle cell anemia (hetero- and homozygous) and who were admitted from January 1987 through December 2004 for splenic rupture or referred for prophylactic splenectomy.

Results: The patients' mean age at splenectomy was 9 years 6 months. Five were homozygous and three heterozygous; on Hackett's scale, spleen size was 4 for four patients and 5 for the other four. All had episodes of pain of the left hypochondrium before surgery and were averaging one blood transfusion a year. Five splenectomies were for traumatic rupture of splenomegaly and three for other splenic complications. Splenectomy made it possible to decrease the frequency of blood transfusions. Pre- and postoperative prophylaxis against infection included penicillin and vaccinations.

Conclusion: The review of literature shows a frequent loss of immune function in the enlarged spleens of children with sickle cell anemia. The authors propose prophylactic splenectomy in children with splenomegaly, to prevent the risk of splenic rupture and other complications. Preventive measures after the splenectomy are necessary to control infections.