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. 2024 Nov 21;16(11):e74186.
doi: 10.7759/cureus.74186. eCollection 2024 Nov.

Cardiovascular Effects of Splenomegaly and Splenectomy in Beta-Thalassemia Major

Sumira Abbas  1   2 , Haris Ali Khan  3 , Wajeeha Rehman  4 , Mian Mufarih Shah  5 , Muhammad Mustafa  6   7 , Muhammad Abbas  8   9
Affiliations

Cardiovascular Effects of Splenomegaly and Splenectomy in Beta-Thalassemia Major

Sumira Abbas et al. Cureus. .

Abstract

Background Beta-thalassemia major is a genetic blood disease complicated by splenomegaly, and splenectomy is a standard therapy for this medical condition. Although splenectomy results not only in the improvement of the hematological status, the long-term consequences to the cardiovascular system are still questionable. Objective The aim of the study was to assess and compare the cardiovascular impact of splenomegaly and splenectomy in patients with beta-thalassemia major. Methodology This is a cross-sectional survey conducted at Hayatabad Medical Complex, Peshawar, from January 2024 to June 2024. A total of 88 beta-thalassemia major patients were divided into two groups: 44 patients with splenomegaly were recruited and compared with 44 post-splenectomy patients. Outcomes that were assessed in this study from the medical records were cardiac function test, ejection fraction, left ventricular hypertrophy, thromboembolic incidences, pulmonary embolism, deep vein thrombosis, blood pressure level, and the biochemical markers, B-type natriuretic peptide (BNP) and troponin. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, USA). Results Patients with splenectomy exhibited slightly lower hemoglobin levels and higher transfusion requirements but had better ejection fractions compared to those with splenomegaly. In contrast, the splenomegaly group demonstrated worse cardiovascular outcomes, including higher rates of left ventricular hypertrophy, pulmonary hypertension, arrhythmias, thromboembolic events, and elevated BNP levels, indicating increased cardiovascular morbidity and hemodynamic strain. Logistic regression analysis further suggested that splenectomy reduces the risk of cardiomyopathy, particularly in younger patients, while the splenomegaly group experiences a greater burden of acute cardiovascular complications. Conclusion Splenectomy in beta-thalassemia major patients offers improved cardiac function and hemoglobin levels while reducing transfusion needs, but it does not eliminate the risks of long-term cardiovascular and thromboembolic complications, such as deep vein thrombosis and pulmonary embolism. On the other hand, patients with splenomegaly face more severe and immediate cardiovascular risks, including hypertension, arrhythmias, and thromboembolic events. These findings underscore the importance of tailored management strategies to optimize outcomes for both groups.

Keywords: beta-thalassemia major; blood pressure; cardiovascular function; ejection fraction; splenectomy; splenomegaly; thromboembolic events.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Institutional Research and Ethical Board of Hayatabad Medical Complex (HMC) issued approval Ethical Approval No: 2289, Doc. No: HMC-QAD-F, Approval Date: 16.10.2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. The Relationship between Age and Ejection Fraction by Linear Regression Model
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