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. 2025 Jun;206(6):1811-1821.
doi: 10.1111/bjh.20114. Epub 2025 Apr 29.

Underlying disease is the main risk factor in post-splenectomy complication risk: Data from a national database

Maddalena Casale  1 , Raffaella Colombatti  2 , Manuela Balocco  3 , Paola Corti  4 , Susanna Barella  5 , Giovanna Graziadei  6 , Loredana Farinasso  7 , Tommaso Mina  8 , Simone Cesaro  9 , Tommaso Casini  10 , Fiorina Giona  11 , Saverio Ladogana  12 , Pellegrina Pugliese  13 , Lucia Dora Notarangelo  14 , Antonella Sau  15 , Simone Ferrero  16 , Giovanni Palazzi  17 , Giovanna Russo  18 , Ilaria Lazzareschi  19 , Marilena Serra  20 , Saveria Campisi  21 , Gianluca Boscarol  22 , Elena Facchini  23 , Carlo Baronci  24 , Maria Caterina Putti  11 , Domenico Roberti  1 , Marzia Manilia  1 , Antonio Ivan Lazzarino  25 , Gian Luca Forni  26 , Silverio Perrotta  1 ; Italian Network of Asplenia
Collaborators, Affiliations

Underlying disease is the main risk factor in post-splenectomy complication risk: Data from a national database

Maddalena Casale et al. Br J Haematol. 2025 Jun.

Abstract

Splenectomy is required for many haematological conditions and causes an increased risk of severe infections and vascular events. The association between underlying haematological disease, age at splenectomy and post-splenectomy complications was explored among 1348 splenectomized patients, followed with a median follow-up time of 13 years and affected by transfusion-dependent thalassaemia, non-transfusion-dependent thalassaemia (NTDT), sickle cell anaemia (SCA), congenital haemolytic anaemias, autoimmune haematological disorders and trauma. Our main statistical approach was based on interaction analyses within competing-risk survival models. The baseline risk profile differed across diagnostic categories, with SCA being particularly susceptible to infectious complications and NTDT and SCA to vascular events (p < 0.001). The age at splenectomy did not impact on infectious risk but rather older age at splenectomy was associated with increased risk for vascular complications. Furthermore, the risk of developing a post-splenectomy complication was persistent throughout the observation period and not limited to the first 2-3 years after splenectomy. The probability of a post-splenectomy complication was highly dependent on the underlying disease and not on the age at splenectomy, so the indications for splenectomy must be based on careful assessment of pros and cons in the individual disease, with no need to delay surgery after a certain age when clinically indicated.

Keywords: children; infection; post‐splenectomy complications; splenectomy; thrombosis.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Incidence rate for an infectious complication year by year for each diagnostic group. AHD, autoimmune haematological disease; CHA, congenital haemolytic anaemia; NTDT, non‐transfusion‐dependent thalassaemia; SCA, sickle cell anaemia; TDT, transfusion‐dependent thalassaemia.
FIGURE 2
FIGURE 2
Incidence rate for a vascular complication year by year for each diagnostic group. AHD, autoimmune haematological disease; CHA, congenital haemolytic anaemia; NTDT, non‐transfusion‐dependent thalassaemia; SCA, sickle cell anaemia; TDT, transfusion‐dependent thalassaemia.
FIGURE 3
FIGURE 3
Cumulative risk for an infectious complication after splenectomy by age categories.
FIGURE 4
FIGURE 4
Cumulative risk for a vascular complication after splenectomy by age categories.
See this image and copyright information in PMC

References

    1. Di Sabatino A, Carsetti R, Corazza GR. Post‐splenectomy and hyposplenic states. Lancet. 2011;378(9785):86–97. - PubMed
    1. Casale M, Cinque P, Ricchi P, Costantini S, Spasiano A, Prossomariti L, et al. Effect of splenectomy on iron balance in patients with β‐thalassemia major: a long‐term follow‐up. Eur J Haematol. 2013;91(1):69–73. - PubMed
    1. Casale M, Perrotta S. Splenectomy for hereditary spherocytosis: complete, partial or not at all? Expert Rev Hematol. 2011;4(6):627–635. - PubMed
    1. Fermo E, Vercellati C, Marcello AP, Zaninoni A, Aytac S, Cetin M, et al. Clinical and molecular spectrum of glucose‐6‐phosphate isomerase deficiency. Report of 12 new cases. Front Physiol. 2019;10:467. - PMC - PubMed
    1. Pizzi M, Fuligni F, Santoro L, Sabattini E, Ichino M, De Vito R, et al. Spleen histology in children with sickle cell disease and hereditary spherocytosis: hints on the disease pathophysiology. Hum Pathol. 2017;60:95–103. - PubMed