A prospective study of postoperative outcome following splenectomy in immunocompromised thalassemia patient with special reference to CD4 count

Monali Madhukar Patole, Mandar Madhukar Patole, Manoranjan Ghosh


Background: Thalassemia are inherited blood disorders that can result in the abnormal formation of hemoglobin. Splenectomy is indicated in the transfusion-dependent patient when hypersplenism increases blood transfusion requirement and prevents adequate control of body iron with chelation therapy. Ninety percent of recipients transfused with HIV antibody-positive blood are found to be HIV infected at follow-up. Prevailing literature on effects of splenectomy on CD4 count suggests that splenectomy causes an abrupt and prolonged increase in CD4 cell count. The aims and objectives this is an Institution based prospective observational study with the aim to observe postoperative outcome in immunocompromised thalassemic patients following splenectomy, postoperative outcome following splenectomy in a patient with low CD4 count and to analyze the effect of CD 4 count if any on different patients in terms of wound infection, chest infection , urinary tract infection or infection at any other site.

Methods: The study included twenty immunocompromised thalassemia Patients attending in Pediatric Surgery OPD and admitted to Paediatric Surgery department of Medical college and hospital Kolkata with splenomegaly and HIV infection for splenectomy, between January 2015 to December 2016.Simple comparative analysis of gathered data was used to evaluate postoperative outcome m and the preop and the post op CD4 count levels of splenectomised thalassaemic patients.

Results: Most patients in this study were in the (3-8) years age group and all are HIV positive patients with thalassemia. In this study author found there was increased CD4 count after splenectomy and postoperative period one patient developed postoperative oral candidiasis.

Conclusions: HIV-infected thalassaemic patients on ART can now safely undergo major splenectomy surgery with encouraging results and in patients with a low CD4 count, there is no relation of CD4 count and splenectomy outcome.


CD4 count, Human immunodeficiency virus infection immunocompromised, Splenectomy, Thalassemia, Transfusion in thalassemia patients

Full Text:



Modell B, Petrou M. Management of thalassaemia major. Arch Dis Child. 1983;58(12):1026-30.

Cohen A, Gayer R, Mizanin J. Long‐term effect of splenectomy on transfusion requirements in thalassemia major. Am J Hematol. 1989;30(4):254-6.

Smith CH, Erlandson ME, Stern G, Hilgartner MW. Postsplenectomy infection in Cooley's anemia: An appraisal of the problem in this and other blood disorders, with a consideration of prophylaxis. New Engl J Med. 1962;266(15):737-43.

Hansen K, Singer DB. Asplenic-hyposplenic overwhelming sepsis: postsplenectomy sepsis revisited. Pediatr Develop Pathol. 2001;4(2):105-21.

Looareesuwan S, Suntharasamai P, Webster HK, Ho M. Malaria in splenectomized patients: report of four cases and review. Clini Inf Dis. 1993;16(3):361-6.

Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res. 2004; 120(4):305-15.

Issaragrisil S. Infection in thalassemia: a retrospective study of 1,018 patients with β-thalassemia/Hb E. Birth Defects Orig Artic Ser. 1988;23:505-11.

Davies JM, Barnes R, Milligan D. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clini Med. 2002;2(5):440-3.

Kim HC, Raska K, Trooskin S, Saidi P. Immune thrombocytopenia in hemophiliacs infected with human immunodeficiency virus and their response to splenectomy. Archiv Int Med. 1989 ;149(7):1685-8.

Barbui T, Cortelazzo S, Minetti B, Galli M, Buelli M. Does splenectomy enhance risk of AIDS in HIV-positive patients with chronic thrombocytopenia?. Lancet. 1987;2(8554):342.

Landonio G, Galli M, Nosari A, Lazzarin A, Cipriani D, Crocchiolo P, et al. HIV-related severe thrombocytopenia in intravenous drug users: prevalence, response to therapy in a medium-term follow-up, and pathogenetic evaluation. AIDS. 1990;4(1):29-34.

Tyler DS, Shaunak SU, Bartlett JA, Iglehart JD. HIV-1-associated thrombocytopenia. The role of splenectomy. Annal Surg. 1990;211(2):211.

Ballet JJ, Sulcebe G, Couderc LJ, Danon F, Rabian C, Lathrop M, et al. Impaired anti-pneumococcal antibody response in patients with AIDS-related persistent generalized lymphadenopathy. Clini Experiment Immunol. 1987;68(3):479.

Uzunkoy A, Harma M, Harma M. Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J gastroenterol: WJG. 2004 Dec 15;10(24):3647.

Rahal W, Debari J, Kuo YH, Casey K, Davis JM. Is impaired immunity a consequence of surgery in patients infected by the human immunodeficiency virus?. Surg Inf. 2007;8(6):575-80.