PURPOSE: Despite advances in immune prophylaxis, sepsis remains the most feared complication following splenectomy for acute splenic sequestration crisis (ASSC) in children with sickle cell anemia (SCA). We seek to investigate the true prevalence of sepsis and other complications of splenectomy in this patient population. METHODS: We reviewed the records of children with SCA (HbSS) who underwent splenectomy for ASSC between 1993 and 2008 at a single institution. RESULTS: Fifty-eight patients (33 males) at a median age of 2 years at splenectomy were included with an average post-splenectomy follow-up of 6.4 years (range 6 months-14 years). Thirty-seven patients (64%) underwent laparoscopic splenectomy, and acute chest syndrome (ACS) was the most common post-operative complication (6.9%). There was no difference in the incidence of sepsis pre- and post-splenectomy. The occurrence of vaso-occlusive pain crises (VOC) and ACS was significantly higher after splenectomy. In addition, 14 patients (24%) developed stroke (n = 5) or an abnormal transcranial Doppler (TCD) (n = 9) after splenectomy. CONCLUSION: Our data suggest that splenectomy can be safely performed in children with SCA given a low risk of sepsis. However, the increased incidence of VOC, ACS, and stroke or abnormal TCDs after splenectomy remains a concern.
PURPOSE: Despite advances in immune prophylaxis, sepsis remains the most feared complication following splenectomy for acute splenic sequestration crisis (ASSC) in children with sickle cell anemia (SCA). We seek to investigate the true prevalence of sepsis and other complications of splenectomy in this patient population. METHODS: We reviewed the records of children with SCA (HbSS) who underwent splenectomy for ASSC between 1993 and 2008 at a single institution. RESULTS: Fifty-eight patients (33 males) at a median age of 2 years at splenectomy were included with an average post-splenectomy follow-up of 6.4 years (range 6 months-14 years). Thirty-seven patients (64%) underwent laparoscopic splenectomy, and acute chest syndrome (ACS) was the most common post-operative complication (6.9%). There was no difference in the incidence of sepsis pre- and post-splenectomy. The occurrence of vaso-occlusive pain crises (VOC) and ACS was significantly higher after splenectomy. In addition, 14 patients (24%) developed stroke (n = 5) or an abnormal transcranial Doppler (TCD) (n = 9) after splenectomy. CONCLUSION: Our data suggest that splenectomy can be safely performed in children with SCA given a low risk of sepsis. However, the increased incidence of VOC, ACS, and stroke or abnormal TCDs after splenectomy remains a concern.
Authors: K Ohene-Frempong; S J Weiner; L A Sleeper; S T Miller; S Embury; J W Moohr; D L Wethers; C H Pegelow; F M Gill Journal: Blood Date: 1998-01-01 Impact factor: 22.113
Authors: F M Gill; L A Sleeper; S J Weiner; A K Brown; R Bellevue; R Grover; C H Pegelow; E Vichinsky Journal: Blood Date: 1995-07-15 Impact factor: 22.113
Authors: Henry E Rice; Brian R Englum; Jennifer Rothman; Sarah Leonard; Audra Reiter; Courtney Thornburg; Mary Brindle; Nicola Wright; Matthew M Heeney; Charles Smithers; Rebeccah L Brown; Theodosia Kalfa; Jacob C Langer; Michaela Cada; Keith T Oldham; J Paul Scott; Shawn St Peter; Mukta Sharma; Andrew M Davidoff; Kerri Nottage; Kathryn Bernabe; David B Wilson; Sanjeev Dutta; Bertil Glader; Shelley E Crary; Melvin S Dassinger; Levette Dunbar; Saleem Islam; Manjusha Kumar; Fred Rescorla; Steve Bruch; Andrew Campbell; Mary Austin; Robert Sidonio; Martin L Blakely Journal: Am J Hematol Date: 2014-11-24 Impact factor: 10.047
Authors: Sofia Mouttalib; Henry E Rice; Denise Snyder; Justin S Levens; Audra Reiter; Pauline Soler; Jennifer A Rothman; Courtney D Thornburg Journal: Pediatr Blood Cancer Date: 2012-01-11 Impact factor: 3.167