Splenectomy and its relation to non-transfusion-transmitted infection in thalassemic patients
Keywords:
splenectomy, thalassemia, non transfusion-transmitted infection, risk factors, mild infection
Abstract
Background Splenectomy has been associated with an increasedsusceptibility to infection. Overwhelming postspelenectomy infec-
tion (OPSI) can lead to high mortality. Decreased IgM and tuftsin
concentration on splenectomized patients seems to play a role in
infection’s susceptibility. Many studies have been performed to
determine the risk factors of infection in thalassemic patients.
Objective To find out morbidity patterns and risk factors for pre-
dicting the likelihood of infection in splenectomized thalassemic
patients.
Methods A retrospective cross sectional study was conducted on
confirmed thalassemic children who came to Department of Child
Health, Cipto Mangunkusumo Hospital within the period of 1973-
2003. Splenectomized patients were categorized as cases group
and non-splenectomized patients as control group. Risk factors for
development of common cold and diarrhea were analyzed using
chi-square test with level of significance <0.05.
Results A total of 300 thalassemic patients, 100 of them were sple-
nectomized, were enrolled in this study. The 15-year-age group or
above is the most common group underwent splenectomy (35%).
Common cold is the most common mild infection in both splenec-
tomized group (75%) and non-splenectomized (71%). A significant
association was found between the risk of infection and splenec-
tomy in thalassemic patients (OR=3.8;CI=2.2;6.62; P=0.000). As-
sociation between time after splenectomy and frequency of com-
mon cold in thalassemia was significant (OR=2.85;CI=1.16;7.14;
P=0.011). Severe infection and acute diarrhea were considered
not significantly different between the two groups.
Conclusion Splenectomy in thalassemia can increase the sus-
ceptibility of non-transfusion-transmitted mild infection. Further
study is needed to elaborate this finding
References
1. Lo L, Singer ST. Thalassemia: Current approach to an
old desease. Pediatr Clin North Am 2002;49:1165-91.
2. Wahidiyat I. Transfusi darah pada Thalassemia. In:
Gatot D, Abdulsalam M, Windiastuti E. Pendidikan
kedokteran berkelanjutan Ilmu Kesehatan Anak XLI.
Darah dan tumbuh kembang: Aspek transfusi. Jakarta,
24-25 Juni, 1998; p. 41-6.
3. Pearson HA, Cohen AR, Giardina PJ, Kazazian HH.
The changing profile of homozygous b-thalassemia:
Demography, ethnicity, and age distribution of current
North American patients and changes in two dicades.
Pediatrics 1996;97:352-6.
4. Wanachiwanawin W. Infections in E- β Thalassemia. J
Pediatr Hematol Oncol 2000;22:581-7.
5. Brock JH. Iron and the immune system. In: Lauffer
RB, editor. Iron and human disease. Florida: CRC Press,
1992. p. 161-78.
6. Saigean M, Abdee J, Zaman-Vaziree M, Khajehian A.
Comparison of neuthrophil function in patient with
thalassemia major and healthy control. Arch Iranian
Med 2002;5(3):175-8.
7. Khan AJ, Lee CK, Wolff JA, Chang H, Khan P, Evans
HE. Defects of neutrophil chemotaxis and random
migration in thalassemia major. Pediatrics 1977;
60:349-51.
8. Styrt B. Infection associated with asplenia: Risk, mecha-
nisms, and prevention. Am J Med 1990; 88(5N):33-42N.
9. Emond AM, Morais P, Venugopal S, Carpenter RG,
Serjeant GR. Role of splenectomy in homozygous sickle
cell disease in chilhood. Lancet 1984;14:88-90.
10. Cohen AR. Infections in Thalassemia Intermedia. Pre-
sented at Thalassemia Intermedia: A region I Confer-
ence. Boston; 1996 November 14.
11. Lynch A, Tobias JD. Life-threatening infection in two
children with hemoglobin S-beta-thalassemia. J Pediatr
1995;126:581-2
12. Al-Salem AH, Qaisaruddin S, Nasserallah Z, Al
Dabbous I, Al Jam’a A. Splenectomy in patients with
sickle-cell disease. Am J Surg 1996;172:254-8.
13. Al-Salem, Naserullah Z, Qaisaruddin S, Al-Dabbous
I, Al Abkari H, Al-Jam’a A, et al. Splenectomy for he-
matological diseases: The qatif central hospital expe-
rience. Ann Saudi Med 1999;19(4):325-30.
14. Spirer Z, Zakuth V, Diamant S, Mondorf W, Stefanescu
T, Stabinsky Y, et al. Decreased tuftsin concentrations
in patients who have undergone splenectomy. Br Med
J 1977;2:1574-6.
15. Lynch AM, Kapila R. Overwhelming postsplenectomy
infection. Infect Dis Clin North Am 1996;10:693-707.
16. Holdsworth RJ, Irving AD, Cushieri A. Post splenec-
tomy sepsis and its mortality rate: Actual versus per-
ceived risk. Br J Surg 1991:78;1031.
17. Nouri A, Montalembert M, Revillion Y, Girot R. Par-
tial splenectomy in sickle cell syndromes. Arch Dis
Child 1991;66:1070-2.
18. Ruth AD. Kekerapan sakit infeksi non transfusi pada
penderita thalassemia β mayor di RSCM [thesis].
Jakarta: University of Indonesia; 2002.
19. Williams, DN, Kaur B. Postsplenectomy care strategy
to decrease the risk of infection. Postgrad Med 1996;
100:195-8.
old desease. Pediatr Clin North Am 2002;49:1165-91.
2. Wahidiyat I. Transfusi darah pada Thalassemia. In:
Gatot D, Abdulsalam M, Windiastuti E. Pendidikan
kedokteran berkelanjutan Ilmu Kesehatan Anak XLI.
Darah dan tumbuh kembang: Aspek transfusi. Jakarta,
24-25 Juni, 1998; p. 41-6.
3. Pearson HA, Cohen AR, Giardina PJ, Kazazian HH.
The changing profile of homozygous b-thalassemia:
Demography, ethnicity, and age distribution of current
North American patients and changes in two dicades.
Pediatrics 1996;97:352-6.
4. Wanachiwanawin W. Infections in E- β Thalassemia. J
Pediatr Hematol Oncol 2000;22:581-7.
5. Brock JH. Iron and the immune system. In: Lauffer
RB, editor. Iron and human disease. Florida: CRC Press,
1992. p. 161-78.
6. Saigean M, Abdee J, Zaman-Vaziree M, Khajehian A.
Comparison of neuthrophil function in patient with
thalassemia major and healthy control. Arch Iranian
Med 2002;5(3):175-8.
7. Khan AJ, Lee CK, Wolff JA, Chang H, Khan P, Evans
HE. Defects of neutrophil chemotaxis and random
migration in thalassemia major. Pediatrics 1977;
60:349-51.
8. Styrt B. Infection associated with asplenia: Risk, mecha-
nisms, and prevention. Am J Med 1990; 88(5N):33-42N.
9. Emond AM, Morais P, Venugopal S, Carpenter RG,
Serjeant GR. Role of splenectomy in homozygous sickle
cell disease in chilhood. Lancet 1984;14:88-90.
10. Cohen AR. Infections in Thalassemia Intermedia. Pre-
sented at Thalassemia Intermedia: A region I Confer-
ence. Boston; 1996 November 14.
11. Lynch A, Tobias JD. Life-threatening infection in two
children with hemoglobin S-beta-thalassemia. J Pediatr
1995;126:581-2
12. Al-Salem AH, Qaisaruddin S, Nasserallah Z, Al
Dabbous I, Al Jam’a A. Splenectomy in patients with
sickle-cell disease. Am J Surg 1996;172:254-8.
13. Al-Salem, Naserullah Z, Qaisaruddin S, Al-Dabbous
I, Al Abkari H, Al-Jam’a A, et al. Splenectomy for he-
matological diseases: The qatif central hospital expe-
rience. Ann Saudi Med 1999;19(4):325-30.
14. Spirer Z, Zakuth V, Diamant S, Mondorf W, Stefanescu
T, Stabinsky Y, et al. Decreased tuftsin concentrations
in patients who have undergone splenectomy. Br Med
J 1977;2:1574-6.
15. Lynch AM, Kapila R. Overwhelming postsplenectomy
infection. Infect Dis Clin North Am 1996;10:693-707.
16. Holdsworth RJ, Irving AD, Cushieri A. Post splenec-
tomy sepsis and its mortality rate: Actual versus per-
ceived risk. Br J Surg 1991:78;1031.
17. Nouri A, Montalembert M, Revillion Y, Girot R. Par-
tial splenectomy in sickle cell syndromes. Arch Dis
Child 1991;66:1070-2.
18. Ruth AD. Kekerapan sakit infeksi non transfusi pada
penderita thalassemia β mayor di RSCM [thesis].
Jakarta: University of Indonesia; 2002.
19. Williams, DN, Kaur B. Postsplenectomy care strategy
to decrease the risk of infection. Postgrad Med 1996;
100:195-8.
Published
2016-10-18
How to Cite
1.
Aisyi M, Tumbelaka A, Munthe B, Madiyono B. Splenectomy and its relation to non-transfusion-transmitted infection in thalassemic patients. PI [Internet]. 18Oct.2016 [cited 30Apr.2024];46(3):134-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/916
Section
Articles
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Received 2016-10-14
Accepted 2016-10-14
Published 2016-10-18
Accepted 2016-10-14
Published 2016-10-18
