From the Research
Splenectomy is indicated in hereditary spherocytosis for patients with moderate to severe disease, characterized by significant anemia, recurrent hemolytic crises, growth retardation, or extramedullary hematopoiesis, as evidenced by the most recent study in 2025 1.
Indications for Splenectomy
The procedure is typically recommended for patients with:
- Hemoglobin levels consistently below 8-10 g/dL
- Frequent blood transfusions
- Complications like gallstones or aplastic crises
- Increased need for red cell transfusions, as seen in 66% of patients in a study from 2018 2
- Symptoms related to cholelithiasis, as seen in 34% of patients in a study from 2018 2
Pre-Surgical Considerations
Children should generally be at least 6 years old before undergoing splenectomy to minimize the risk of post-splenectomy sepsis. Prior to surgery, patients should receive vaccinations against encapsulated organisms, including pneumococcal, meningococcal, and Haemophilus influenzae type b vaccines.
Surgical Approach
Laparoscopic splenectomy is now preferred over open surgery due to reduced recovery time and complications, as shown in a study from 2018 where no post-operative complications were observed after laparoscopic splenectomy 2. Partial splenectomy may be considered in young children to preserve some splenic immune function while reducing hemolysis, as supported by a multi-institutional review in 2011 3.
Post-Surgical Care
Following splenectomy, lifelong antibiotic prophylaxis (typically penicillin V 250-500 mg twice daily) is recommended, especially in children. The procedure is effective because the spleen is the primary site of red blood cell destruction in HS; removing it significantly reduces hemolysis, increases red cell survival, and improves anemia, as explained in a study from 2025 1.