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Author Topic: splenectomy for children  (Read 6866 times)
Keep Smiling
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« on: November 23, 2009, 11:37:13 PM »

as u know i m a beginner here, and trying to read as much posts as possile...........so i dont know wether it has been discussed or not
so question is "is splenectomy suitable for children or not keeping in mind all the consequences"


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« Reply #1 on: November 24, 2009, 06:48:47 AM »

ok,i reply to it myself.....
now i realize it was a very childish question
apart from filtering blood, spleen is also responsible for the immune system of the body,
in children the immune system is not yet established completely, so getting them splenectomized makes them more vulnerable to infections......
so, splenectomy is avoided as much as possible in children especially under age 5 and those under 2 are almost never splenectomized except special cases....

m i right?Huh?Huh???
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Zaini
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« Reply #2 on: November 24, 2009, 06:56:06 AM »

You are right Abbas,splenectomy should be avoided,unless its really necessary,i am sorry i don't know much about it but we have members who have had splenectomy,is Najaf's spleen enlarged?
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« Reply #3 on: November 24, 2009, 06:59:35 AM »

i dont know the exact size of spleen for children.....
anyhow Najaf"s one is 3cm
is it enlarged?
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Zaini
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« Reply #4 on: November 25, 2009, 12:09:56 AM »

Abbas,

Check this thread ,

http://www.thalassemiapatientsandfriends.com/index.php?topic=1116.0;highlight=splenectomy

It will answer quite a few questions about splenectomy.

Hope this helps .

Zaini.
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« Reply #5 on: November 25, 2009, 12:28:01 AM »

Hi Abbas,

This is from the Standard of Care Guidelines for Thalassemia which are attached as a pdf file to the post at
 http://www.thalassemiapatientsandfriends.com/index.php?topic=1762.msg14639#msg14639

Quote
4.5 Splenectomy
The use of splenectomy in thalassemia has declined in
recent years
. This is partly due to a decreased prevalence
of hypersplenism in adequately transfused patients.
There is also an increased appreciation of the adverse
effects of splenectomy on blood coagulation. In general,
splenectomy should be avoided unless absolutely indicated.
Splenectomy is indicated in the transfusion-dependent
patient when hypersplenism increases blood transfusion
requirement and prevents adequate control of body iron
with chelation therapy. An enlarged spleen—without an
associated increase in transfusion requirement—is not
necessarily an indication for surgery.
Patients with hypersplenism
may have moderate to enormous splenomegaly,
and some degree of neutropenia or thrombocytopenia
may be present.
Annual transfusion volume exceeding 225 to 250 mL/kg
per year with packed red blood cells (hematocrit 75 percent)
may indicate the presence of hypersplenism. The
volume calculation should be corrected if the average
hematocrit is less than 75 percent. The possible development
of alloantibody should also be ruled out.
Splenectomy should be avoided unless there is an inability
to maintain iron balance with optimal chelation, or if
there are clinically significant complications such as pancytopenia
and marked enlargement. Often, hypersplenism
develops because of a low pre-transfusion
hemoglobin. Increasing the pre-transfusion hemoglobin
to between 9.5 and 10 may reverse hypersplenism.

If a decision to perform surgery is made, partial or full
splenectomy is the option. Partial splenectomy is a complicated
surgery utilized to preserve some splenic function.
It should be reserved for infants requiring splenectomy.
Full splenectomy can usually be performed by
laparoscopic technique. However, open procedure is necessary
in cases of marked splenomegaly. The indications
for splenectomy in hemoglobin H–Constant Spring
patients are different than in beta-thalassemia disorders.
Transfusion-dependent infants with hemoglobin
H–Constant Spring respond rapidly to splenectomy but
require prophylactic anticoagulation because of a high
incidence of serious thrombosis

Splenectomy was once a staple part of treatment for intermedia but unless, the Hb can be kept up in the minor range after splenectomy, it makes little sense. With transfusing patients, splenectomy should not be seen as a routine part of care. The areas above in bold describe the circumstances under which splenectomy may be necessary. Transfusing an intermedia may be preferable to splenectomy in many cases, as this will reverse hypersplenism.
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« Reply #6 on: November 25, 2009, 09:54:33 AM »

Since I was born in the good old times ( ) my spleen and I have been divorced since 1991. I would like to turn into a new direction. How many have heard about the procedure of first doing a splenectomy and then a transplant when  the donor is a carrier? (not my best sentence ever, I know)
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« Reply #7 on: November 25, 2009, 10:11:43 AM »

To be honest Dore,

I have long thought about spleens and transplants.  From my understanding,transplanting some of the donors cells into the recipients spleen may reduce the chance of rejection for bmts. 

I also think that if enough of the donors cells were implanted into the recipient's spleen that much of the problem with thalassemia may be reduced because the spleen is capable of extra medullary hematopoiesis (which is why the spleen increases in size due to low hemoglobin - in attempts to increase it's own surface area, in hopes to produce more red blood cells in order to assist the bone marrow to increase hg - of course in thalassemia this effort is futile because the beta gene is missing) - but if the donor cells in the spleen can make red blood cells it may reduce the anemia.  Furthermore, cells implanted in the spleen also tend to migrate into the bone marrow - causing engraftment. 

If the spleen has accepted donor cells the body tends to accept them too.

Of course these are all theories circulating in my own head, and I don't know what practical significance they would have.  I hope to discuss them with doctors in Oakland in the future. 

Sharmin
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