Benefits to Splenectomy

[SophiaG]

Hello Everyone,

Does anyone have any information regarding the benefits of having a spleen removed if you have Thal Major.

Also, in what circumstances would you have it removed, besides the obvious fact of size.

[Narendra]

Hello SophiaG,

One thing I have heard from some Thal(Major)'s who have got their spleen removed is that the blood transfusion interval is extended (Less blood transfusions, which means less Iron Chelation needed).

Check out :- http://www.thalassaemiaindia.org/ which has some good information related to spleen

Also, you might want to weigh out the disadvantages with removing the spleen along with the benifits of removing the spleen

Your doctor would be able to give decide depending on the size and the transfusion requirements

[SophiaG]

Hi Narendra,

I spoke with my doctor at the Thal Clinic and he stated that there are blood tests to determine if your spleen is working for you or against you. But I agree with your statement regarding extended blood transfusion intervals. Less transfusions and iron chelation is always a good thing.

[Narendra]

Originally Posted by SophiaG

I spoke with my doctor at the Thal Clinic and he stated that there are blood tests to determine if your spleen is working for you or against you. But I agree with your statement regarding extended blood transfusion intervals. Less transfusions and iron chelation is always a good thing.

SophiaG,

Could you let us know what type of blood test determines if the spleen is working or not. I think it is a good thing, as lots of thals struggle to come to conclusion if they should do splenectomy or should avoid it.

Yes, Extended blood transfusion leads to less Iron overload which needs less chelation and better health

[SophiaG]

I believe this test is called an "Epo" test. This test from my understanding determines if your body is producing a horomone that helps produce red blood cells. If the results indicate the horomone is lacking, then the treatment is simple. You will be put on the horomone itself to help stimulate red blood cell growth. If the test determines that the horomone is not lacking, chances are its your spleen. At that time, you can discuss with your doctor if removing the spleen is the right thing to do.

[Neel_R]

I'm confused...why would we want this hormone that produces red cells? Our cell's just break down and die, thus causing a higher iron percentage in our bodies.

[SophiaG]

I think the whole point of this horomone is to increase the life span of these cells so we are not being transfused as often. We would be able to maintain a higher hemoglobin. For example, I was maintaning a HB of 10 post transfusion time (I was going every 5 weeks). Now I can barely make it 4 weeks to a transfusion and my HB at that time is 8.

[Narendra]

Sophia,

Not sure what you meant by saying the hormone is checked to see if it increases the life span of these cells.

I read that the spleen filters the bad RBC (Red Blood Cells). But, with an enlarged spleen sometimes it also filters the good RBCs

From:- http://www.emedicine.com/PED/topic2229.htm

The spleen is known to contain a large amount of the labile nontoxic iron (ie, storage function) derived from sequestration of the released iron.
The spleen also increases RBC destruction and iron distribution (ie, scavenger function).

Some information is from:- http://www.thalassaemiaindia.org

When Splenectomy?
Increase of annual blood requirement by 50% or more over initial requirement.
Presence of massive splenomegaly.
When size of spleen is 6-8 cm or upto the naval, splenectomy should be considered seriously.

Why Splenectomy?
Patients with Thalassemia Intermedia & Major invariably develop splenomegaly due to ineffective production of blood cells in spleen and iron deposition.
This hypersplenism causes increased destruction of red cells resulting in increased blood requirement, increased iron load & enhanced risk of transfusion transmitted infections.
In addition to destroying the older red blood cells, the overactive spleen also destroys some white blood cells(WBCs), platelets and young red blood cells, further worsening the anemia.
The red blood cells circulating in the system of the patients with thal have an abnormal shape because they lack normal Hb molecules, and often become trapped in the spleen - which adds to the size of the spleen.

Also, the spleen may also attempt to counteract the body's anemia by producing red blood cells itself (also called extramedullary erythropoeisis), which further contributes to the spleens enlargement

Advantage of Splenectomy
Spleen removal might reduce your transfusion requirement
A non-splenectomised patient requires approximately 180 ml of red blood cells/kg/year while a splenectomised patient requires about 133 ml/kg/year

Risks
Splenectomy significantly increases the risk of serious infection and preferably be postponed to after 6th year of age
Patient should be immunized against Pneumococcal, Meningococcal A & C & Haemophilus influenza B (HiB), 4-6 weeks prior to operation.

After Splenectomy
Prolonged Penicillin prophylaxis (250 mg bd) or injection Benzethine Penicillin 6-12 lacs every 3 weeks should be prescribed post Splenectomy.
Post splenectomy fevers/upper respiratory infections/any infection should be managed promptly.
Broad spectrum antibodies including amoxycillin/co-trimoxazole should be started at home.
Patient should be hospitalised if fever doesnot subside within 48 hours.
Aspirin 50-100mg/day may be advised if platelet count exceeds 8,00,000/mm3

[vamanjani]

SophiaG,
Narendra has furnished requisite details and I desire to elaborate a little on the function of spleen for better understanding only.
The spleen performs several important functions, including protecting the body from infection by filtering the blood to remove any invading microbes, bacteria and parasites. The spleen is also responsible for removing red blood cells at the end of their lifecycle from the circulation, breaking them down to release the globin and iron from their haemoglobin to be reused in making new cells. In patients with thalassaemia major, however, this recycling process does not work properly. Instead the iron is deposited in the spleen or released into the blood stream and transferred back to the spleen. Red blood cells produced in thalasaemics are abnormal in shape and so get stuck in the spleen. As a result, the spleen grows larger and larger, often forcing abdomen to grow along with it.
The spleen often becomes hyperactive - a condition known as hypersplenism - and in the process also destroys the normal red blood cells the patient receive by blood transfusions. As a result, the patient requires more blood at each transfusion. A hyperactive spleen may also destroy other components of the blood such as W.B.C. and thrombocytes.
Hypersplenism cannot be corrected, it must surgically be removed which is now considered a relatively straightforward surgical procedure.
After splenectomy, there is the risk of developing infections and some of these infections can prove fatal as well. The risk of infection is very high in patient in the age group of 5 and below.
Overall, the best approach is to avaoid problems of the spleen altogether by administering safe and appropriately processed blood as soon as a diagnosis of thalassaemia major is confirmed, keeping Hb level above 9-10g/dl. In this way, the development of an enlarged spleen may be delayed and even prevented, avoiding the need for a splenectomy. Maintaining the spleen in its normal size helps ensure the efficiency of blood transfusions.

[Neel_R]

That is some very good information. It would be wise then for all Thal Majors to get this 'Epo' test done maybe once a year?

I have a feeling I could have an enlarged spleen, when I was young I used to get quite a bit of blood, and as I was in adolensen I was not to commited to my pump.

I am assuming this is major surgery yes? Does anyone know what the timeline is for this type of surgery? Like how long would someone miss work for? Not be able to play sports? etc...

[SophiaG]

I think the EPO test is a good idea too.

As far as the surgery to remove the spleen, it differs from patient to patient-assuming size is the concern. I heard you can have it removed through your belly button. This is to avoid an incision in your stomach. Any surgery is major surgery in my eyes and should be taken seriously. I also think healing is individual. But I would think you would be out for a few days to 2 weeks depending how the doctors removed the spleen.

[vamanjani]

Hi Neel_R
Hypersplenism cannot be corrected. Therefore, once it is confirmed that the spleen is performing in a way that is harmful to the body, it must be surgically removed.
Adecision to remove the spleen should be taken after careful consideration of a number of dedical factors including the following important crieteria.
1. An oversized spleen - usually more than 6cm in length - and resulting in discomfort.
2. An increasing amount of blood required to transfuse a patient with no ther medical problems - i.e. when the amount of blood required increases 15 times or more than 200-220ml/kg/year of packed red cells are required to maintain average Hb level.
3. The age of the patient, who should be over 5 syearsold. The spleen plays an important role in defending the body against infection. Removing spleen therefore, increases the risk of serious infection in children under 5, this risk is particularly high as their immune system is not yet mature.
There are three techniques aimed at preventing or minimising the risk of infection in patients whok undergo splenectomy.
1. IMMUNOPROPHYLAXIX: Immunisation with the pneumococcal, haemophilus influenza and meningococcal vaccines. Vaccinations mormally begin about two weeks before surgery and are repeated after surgery according to recommended guidelines.
2. CHEMOPROPHYLAXIS: Antibiotics - normally orala penicilin - are administered 125mg b.i.d. for children under 2 and 250mg b.i.d. for children over 2. However, the duration of use varies greatl from case to case.
3. Attention to raised PLATELET count. An increased platlet count can occur after splenectomy i.e. above 800000/mm3. This condition can be managed by administering 50-100gm aspirin/day untill the platlet count returns to normal.
Hoe, this will help you as necessary guidelines.

[tinaki]

Hi SophiaG,

I have thal major and I had my spleen removed when I was 12 (I am now 38). Back then it was thought that by removing your spleen it would decrease your need for transfusions and would therefore lessen iron overload.

My spleen was quite enlarged so it was thought best to get rid of it. I have not had any change in the frequency of transfusions, I still require 2 - 3 units every 4 weeks. I have yet to meet a Thal major that has had their spleen taken out and needs less blood.

One thing that is rarely mentioned is that you may need to go on daily antibiotics to fight off infections that the spleen naturally filters.

I hope this helps.

[TomK]

Dear all,

I know this reply is more than a month after the last post but I feel very strongly about splenectomy.

I have thal major, I'm 33yo, went through the whole consultation back in 1995 (I was 20 yo) and the doctors advised in favour of removing the spleen for the reasons that have been stated in this thread. I have never regretted anything more than having my spleen removed.

I completely agree with Tinaki. My transfusions did not become less frequent, not even immediately after the operation, and instead of benefits I got lots of complications namely: I had to be on antibiotics for 2 years after (compulsory) and then reccomended for lifetime (which I did not and still refuse to this day). My immune system had weakened even more (I was getting reccurent tonsilitis 3 times a year, my intestinal bacterial flora got imbalanced and I now have intestinal candida overgrowth - conventional doctors do not want to hear about these problems).

I know I am biased but this is my experience. Besides the emotional and psychological issues associated with the physical and emotional scars.

If I could turn back time and my spleen was severely enlarged, I would try homeopathy (I know a girl who succesfully reverted hypersplinism with homeopathy) or other complementary methods.

[rajeshpop]

Originally Posted by tinaki

Hi SophiaG,

I have thal major and I had my spleen removed when I was 12 (I am now 38). Back then it was thought that by removing your spleen it would decrease your need for transfusions and would therefore lessen iron overload.

My spleen was quite enlarged so it was thought best to get rid of it. I have not had any change in the frequency of transfusions, I still require 2 - 3 units every 4 weeks. I have yet to meet a Thal major that has had their spleen taken out and needs less blood.

One thing that is rarely mentioned is that you may need to go on daily antibiotics to fight off infections that the spleen naturally filters.

I hope this helps.

The Spleen was removed because it was enlarged as well your requirement for transfusion was every 3rd day so the benefit is now every 4th week.
with regards