To determine the advantages and complications of
splenectomy in the treatment of
beta thalassemia, 221
splenectomies for
thalassemia performed upon pediatric patients from 1971 to 1982 are evaluated. There were 125 boys and 96 girls with a mean age of 8.2 +/- 2.5 years at the time of the operation. Sixty-one other patients who underwent
splenectomy for other diseases served as the controls. Early and late complications after
splenectomy are considered with a follow-up study of ten years.
Hemoglobin (Hb) value, transfusional quotients and mean of transfused blood previous to surgical treatment are matched with the same parameters evaluated during the follow-up period. The effect of treatment with
salicylates and
dipyridamole upon the incidence of early complications after operation is analyzed. The postoperative complications in patients with
thalassemia were 43.4 versus 3.2 per cent (p less than 0.01) registered in control patients. Late complications occurred with an incidence of 10.7 per cent and were due principally to
sepsis. Six patients died of
sepsis during the follow-up period, but the mortality rate for
sepsis in the patients we studied was significantly lower than that reported by others in 73 instances of
splenectomy for
beta thalassemia. Blood consumption dropped from 270 +/- 99 to 155 +/- 31 milliliters per kilogram per year postoperatively (p less than 0.01) and Hb levels rose from 9.7 +/- 1.3 to 11.2 +/- 0.7 grams per milliliter. These results suggest that, even though
splenectomy for
beta thalassemia causes a relevant incidence of complications and fatalities, surgical treatment permits an improvement in the quality of the lives of patients with
beta thalassemia and significantly reduces blood consumption. Prophylactic
antibiotic therapy can reduce the incidence of
sepsis, as was observed in the patients we studied.