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Volume 16, Issue 3 (6-2026)
Iran J Ped Hematol Oncol 2026, 16(3): 948-960 |
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Ethics code: IR.sums.med.rec.1397.330
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Shahriari M, Banani S A, Bazrafshan A, Haghpanah S, Bahador A, Shakibazad N. Spleen-Saving or Spleen-Sacrificing? Rethinking Splenectomy Strategies in Thalassemia. Iran J Ped Hematol Oncol 2026; 16 (3) :948-960
URL: http://ijpho.ssu.ac.ir/article-1-969-en.html
URL: http://ijpho.ssu.ac.ir/article-1-969-en.html
Mahdi Shahriari 
, Seyed Abbas Banani , Asghar Bazrafshan , Sezaneh Haghpanah , Ali Bahador , Nader Shakibazad *
, Seyed Abbas Banani , Asghar Bazrafshan , Sezaneh Haghpanah , Ali Bahador , Nader Shakibazad *
Bushehr University of Medical Sciences, Bushehr, Iran & Associate professor of pediatric hematology and oncology, Bushehr University of Medical Sciences, Bushehr, Iran
Abstract: (10 Views)
Background: Splenomegaly and hypersplenism are common complications in thalassemia that may require splenectomy. Although total splenectomy (TS) effectively improves hematologic parameters, it is associated with increased risks of infection and thrombosis. Partial splenectomy (PS) has been proposed as a spleen-preserving alternative to reduce these complications. This study compares the clinical outcomes of PS and TS in patients with thalassemia.
Materials and Methods: In this retrospective study, 74 thalassemia patients who underwent splenectomy from 2011 to 2018 were analyzed (median follow-up: 4 years). Twenty-five patients (33.8%) underwent PS, and 49 (66.2%) underwent TS. The outcomes, including hematologic improvement, transfusion intervals, incidence of diabetes mellitus, thrombotic events, and infection-related complications, were compared between the groups. The results were analyzed using an independent t-test, Fisher’s exact test, and logistic regression.
Results: In this study, both PS and TS groups showed significant post-operative improvements in hemoglobin levels (P < 0.0001). However, complications varied notably between the two groups. Diabetes mellitus developed in 12 patients (16.2% overall); only one case (4%) occurred in the PS group, while 11 cases (22.4%) were observed in the TS group. This corresponded to a significantly higher odds of diabetes after total splenectomy (OR = 6.9; 95% CI: 0.22–32.22; P = 0.04). The wide confidence interval reflects the small number of events, particularly in the PS group. Moreover, 13 cases of infection were observed exclusively in the TS group.
Conclusion: Partial splenectomy may serve as a safer alternative to total splenectomy in thalassemia patients, providing hematologic benefits while reducing the risk of infectious and metabolic complications. Further prospective studies are warranted to validate this finding.
Materials and Methods: In this retrospective study, 74 thalassemia patients who underwent splenectomy from 2011 to 2018 were analyzed (median follow-up: 4 years). Twenty-five patients (33.8%) underwent PS, and 49 (66.2%) underwent TS. The outcomes, including hematologic improvement, transfusion intervals, incidence of diabetes mellitus, thrombotic events, and infection-related complications, were compared between the groups. The results were analyzed using an independent t-test, Fisher’s exact test, and logistic regression.
Results: In this study, both PS and TS groups showed significant post-operative improvements in hemoglobin levels (P < 0.0001). However, complications varied notably between the two groups. Diabetes mellitus developed in 12 patients (16.2% overall); only one case (4%) occurred in the PS group, while 11 cases (22.4%) were observed in the TS group. This corresponded to a significantly higher odds of diabetes after total splenectomy (OR = 6.9; 95% CI: 0.22–32.22; P = 0.04). The wide confidence interval reflects the small number of events, particularly in the PS group. Moreover, 13 cases of infection were observed exclusively in the TS group.
Conclusion: Partial splenectomy may serve as a safer alternative to total splenectomy in thalassemia patients, providing hematologic benefits while reducing the risk of infectious and metabolic complications. Further prospective studies are warranted to validate this finding.
Type of Study: Research |
Subject:
Hematology
Received: 2025/07/30 | Accepted: 2026/04/27 | Published: 2026/06/17
Received: 2025/07/30 | Accepted: 2026/04/27 | Published: 2026/06/17
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