Persistent Thrombocytosis, an Interesting Finding in β-Thalassemia Patients Post-Splenectomy in a Tertiary Referral Center in Jordan

Background

β-thalassemia is a common hematological disorder with defective β-globin production. Splenectomy is one of the common modalities of management in its severe forms where blood transfusion requirements are high. However, various post-splenectomy complications, such as thrombocytosis, warrant further exploration.

Methods

This was a retrospective cohort study conducted on 22 patients with β-thalassemia major who had undergone splenectomy at Al-Bashir Hospital, a tertiary referral center in Jordan, from 2019 to 2021. We analyzed demographic data, clinical outcomes (e.g., blood transfusion requirements and intervals), and laboratory values (e.g., hemoglobin and platelets counts) pre- and post-splenectomy. p-values < .05 were considered significant.

Results

All patients with a mean age of 24.71 ± 8.44 years had persistent thrombocytosis post-splenectomy. The average count of platelets peaked at 965.36 ± 413.50 cells/mm³ immediately post-surgery and fell slightly to 843.23 ± 320.08 cells/mm³ one-year post-splenectomy. Transfusion requirements reduced significantly by 42.49% from an average of 295.95 ± 68.24 ml/kg/y to 170.21 ± 54.65 ml/kg/y (p <.001). The average time interval between transfusions has increased by 60.15% from 17.14 ± 4.49 days to 27.45 ± 10.5 days (p <.001). The hemoglobin level showed a significant increase post-splenectomy, with means of 8.47 ± 1.43 g/dL pre-surgery and 9.65 ± 1.49 g/dL post-surgery. Aspirin was recommended to all patients and hydroxyurea was recommended to those with persistent thrombocytosis over 1 million (n=12) but some refused it (n=5).

Conclusions

This study further underscores the persistent thrombocytosis and reduced transfusion needs in β-thalassemia patients following splenectomy. The results of such findings, therefore, indicate that while splenectomy brings very effective control in transfusion requirements, monitoring thrombocytosis and thrombotic events should always be on the lookout. Generally, it brings out the relevance of adopting tailored management strategies to optimize patient outcomes in β-thalassemia care. Future prospective studies involving larger cohorts with a more prolonged duration of follow-up would be required to confirm these observations and define other late complications following splenectomy.

No relevant conflicts of interest to declare.