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Category: Volume 07 Issue 07 July 2019
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Title: A Case Series of Elective Splenectomy in Hemolytic Anemias – Our Experience at a Tertiary Care Hospital in North Coastal Andhra

Authors: Dr Buddha Kanaka Maha Lakhsmi, Dr Vadisetti Satya Niharika, Dr Chinthagada Jaya Raj, Dr Deevi Murali Manohar, Dr Simhadri Uday Kiran

 DOI: https://dx.doi.org/10.18535/jmscr/v7i7.151

Abstract

Hereditary hemolytic anemias are disorders with a variety of causes, including red cell membrane defects, red blood cell enzyme disorders, congenital dyserythropoietic anemias, thalassemia syndromes, and hemoglobinopathies. Splenectomy is one possible therapeutic approach in management and haematological conditions were cited as one of the leading indications. However, the short-term and long-term advantages and challenges that splenectomy offers in the scenario of these anemias is not strongly evidence-based, except for that in hereditary spherocytosis as of now. Aims of our study are to establish the indication for elective splenectomy in adults with hemolytic anemias and to evaluate the effectiveness of splenectomy in treating the indication. We also review our experience in the management of such patients and compare with other studies. A case series of 27 patients over a period of two years from June 2016 to June 2018 referred to our department were included. According to our study, hypersplenism was the most common indication for splenectomy in adult patients with hemolytic anemias. We have followed open approach and performed simultaneous splenectomy and cholecystectomy for all patients with concomitant cholelithiasis. Our study achieved 100% improvement in the indication with minimal comorbidity due to strict adherence to protocols even in these patients. However, more detailed studies in this subset of patients is needed for establishment of guidelines and optimal outcomes.

Keywords: Spleen, hemolytic anemias, adult, hypersplenism, elective, splenectomy.

References

  1. Iolascon A, Andolfo I, Barcellini W, et al. Recommendations regarding splenectomy in hereditary hemolytic anemias. Haematologica. 2017;102(8):1304–1313. doi:10.3324/haematol.2016.161166
  2. Fellows IW, Hart S, Toghill PJ.Trends in splenectomy in the Trent region 1972-85. Postgrad Med J. 1988;64(750):267-70.
  3. Machado NO, Grant CS, Alkindi S, Daar S, Al-Kindy N, Al Lamki Z, et al. Splenectomy for haematological disorders: a single center study in 150 patients from Oman. Int J Surg. 2009;7:476–81.
  4. Ahmed H. Al-Salem, "Splenic Complications of Sickle Cell Anemia and the Role of Splenectomy," ISRN Hematology, vol. 2011, Article ID 864257, 7 pages, 2011. https://doi.org/10.5402/2011/864257.
  5. Bolton-Maggs PH, Langer JC, Iolascon A, Tittensor P, King MJ General Haematology Task Force of the British Committee for Standards in Haematology. Guidelines for the diagnosis and management of hereditary spherocytosis-2011 update.Br J Haematol. 2012;156:37–49.
  6. Uranüs S, Sill H. Splenectomy for hematological disorders. In: Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: https://www.ncbi.nlm.nih.gov/books/NBK6913/
  7. Rehmani B, Kumar N, Pathak P. Changing trends in elective splenectomy at a tertiary hospital in North India: a 10 year study. IntSurg J 2017;4:2589-93.
  8. Berenguer CM, Ochsner  MG  Jr, Lord  SA, Senkowski    Improving surgical site infections: using National Surgical Quality Improvement Program data to institute Surgical Care Improvement Project protocols in improving surgical outcomes.  J Am CollSurg. 2010;210(5):737-743.
  9. Owen RM, Perez  SD, Bornstein  WA, Sweeney    Impact of Surgical Care Improvement Project Inf-9 on postoperative urinary tract infections: do exemptions interfere with quality patient care?  Arch Surg. 2012;147(10):946-953.
  10. Rodeghiero F, Ruggeri   Short- and long-term risks of splenectomy for benign haematological disorders: should we revisit the indications?  Br J Haematol. 2012;158(1):16-29.
  11. Bagrodia N, Button AM, Spanheimer PM, Belding-Schmitt ME, Rosenstein LJ, Mezhir JJ. Morbidity and Mortality Following Elective Splenectomy for Benign and Malignant Hematologic Conditions: Analysis of the American College of Surgeons National Surgical Quality Improvement Program Data. JAMA Surg.2014;149(10):1022–1029. doi:10.1001/jamasurg.2014.285
  12. Bickenbach, K. A., Gonen, M., Labow, D. M., Strong, V., Heaney, M. L., Zelenetz, A. D. and Coit, D. G. (2013), Indications for and efficacy of splenectomy for haematological disorders. Br J Surg, 100: 794-800. doi:10.1002/bjs.9067.

Corresponding Author

Dr Chinthagada Jaya Raj, MS.MCh.

Professor and HOD of Surgery, Department of General Surgery, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India Pin code – 530002