From the Guidelines
Postoperative morbidity after splenectomy for hematologic diseases is highest for patients with sickle cell anemia. This is primarily due to the underlying pathophysiology of sickle cell disease, which includes chronic anemia, increased risk of infections, vaso-occlusive crises, and multi-organ dysfunction. These patients are particularly vulnerable to postoperative complications such as acute chest syndrome, vaso-occlusive pain crises, infections, and thromboembolic events. The altered immune function and increased susceptibility to encapsulated bacterial infections that already exists in sickle cell patients is further compounded by the removal of the spleen, which plays a crucial role in immune function. Additionally, the surgical stress can trigger sickling crises, leading to increased morbidity during the recovery period. Some key points to consider include:
- The risk of postoperative complications in patients with sickle cell disease is high, with an estimated incidence of vaso-occlusive crisis (VOC) of 6% and acute chest syndrome (ACS) of approximately 4% in children 1.
- The management of patients with sickle cell disease undergoing splenectomy requires careful consideration of their individual clinical characteristics, including their history of SCD-related events, impaired cardiovascular or pulmonary function, and concomitant or recent infection 1.
- The use of transfusions and exchange in the setting of high-risk procedures, as well as the prevention of hypothermia and hypoxia, are important considerations in the perioperative management of patients with sickle cell disease 1. In contrast, conditions like idiopathic thrombocytopenic purpura and hereditary spherocytosis typically have better postoperative outcomes following splenectomy, with lower risks of postoperative complications and morbidity 1.
From the Research
Postoperative Morbidity after Splenectomy
- The postoperative morbidity after splenectomy for hematologic diseases is highest for myeloid dysplasia, also known as myelofibrosis 2, 3, 4.
- Studies have shown that patients with myelofibrosis have a higher incidence of complications and postoperative mortality compared to other hematologic diseases 2, 3, 4.
- The high morbidity and mortality rates in patients with myelofibrosis are due to various factors, including massive splenomegaly, elevated operative blood loss, and underlying hematological disease severity 2, 3, 4.
Respiratory Quotient in Prolonged Starvation
- There is no direct evidence in the provided studies to answer this question.
Most Abundant Amino Acid in the Body
- There is no direct evidence in the provided studies to answer this question.
Maximum Efficiency of Glucose Use in Total Parenteral Nutrition
- There is no direct evidence in the provided studies to answer this question.
Refeeding Syndrome
- There is no direct evidence in the provided studies to answer this question.
Eczematoid Rash at Intertriginous Areas with Prolonged Total Parenteral Nutrition
- There is no direct evidence in the provided studies to answer this question.
Volume of Air Moved with Maximum Exhalation after Deep Inhalation
- There is no direct evidence in the provided studies to answer this question.
Bleeding after Adequate Heparin Reversal with Protamine
- There is no direct evidence in the provided studies to answer this question.
Ileocolic Intussusception in Children
- There is no direct evidence in the provided studies to answer this question.