Effect of splenectomy on iron balance in patients with β-thalassemia major: a long-term follow-up

Abstract

Objective: A retrospective study was performed to explore the effect of splenectomy on iron balance in thalassemia major (TM).

Methods: Twenty two TM patients treated with splenectomy were compared with a control group (non-splenectomized patients) matched for sex, age, pretransfusional Hb, chelation therapy, and duration of follow-up in a retrospective study to evaluate blood consumption, iron intake, and serum ferritin during an overall observation period of 6 yrs before and 10 yrs after splenectomy.

Results: Splenectomy improved parameters of iron balance, determining a significant reduction in blood consumption (P < 0.01), iron intake (P < 0.01), and serum ferritin (P < 0.01). Comparing the two groups, blood consumption and iron intake were similar in presplenectomy period (P > 0.05), but serum ferritin was significantly higher in splenectomized patients (P < 0.01). After splenectomy, blood consumption and iron intake were significantly lower (P < 0.01) in splenectomized group while serum ferritin did not differ significantly (P > 0.05) between two groups, except for the first year (P < 0.05).

Conclusion: Splenectomy determines immediate drop in blood consumption and iron intake but slow downtrend of ferritin; direct measurements of iron overload, such as magnetic resonance studies, are needed to better understand the effect of splenectomy on iron balance parameters. Tailoring chelation therapy and eventually its intensification seem more efficient measures to manage iron accumulation in TM and to lower iron level to safety threshold.