Hematological evaluation of splenectomized and non-splenectomized transfusion dependent patients with thalassemia

Background: Thalassemia is a group of blood disorders caused by decreased or absent synthesis of globin chains, with β-thalassemia leading to ineffective erythropoiesis, severe anemia, and the need for lifelong transfusions. Frequent transfusions can cause iron overload, and many transfusion-dependent patients require splenectomy to manage hypersplenism, though the procedure carries potential risks and its benefit on transfusion reduction remains debated. The aim of the study was to compare the hematological profile and iron overload status between splenectomized and non-splenectomized transfusion-dependent patients with thalassemia. Methods: This cross-sectional comparative study at the department of transfusion medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from December 2021 to October 2022, included 60 transfusion-dependent thalassemia patients (30 splenectomized, 30 non-splenectomized). Sociodemographic, nutritional, clinical, transfusion, and laboratory data (CBC, PBF, serum ferritin) were collected and analyzed using SPSS version 24 (p < 0.05). Results: Among 60 patients, splenectomized individuals were more often underweight (76.7% versus 46.7%), had higher hemoglobin (7.26 versus 6.78 gm/dl), MCV (75.64 versus 69.99 fl), WBC (12.24 versus 9.31 ×103/l), platelets (556 versus 210 ×10³/L), and ferritin (5843.98 versus 3253.32 ng/mL), while non-splenectomized patients required more frequent transfusions ≤4 weeks (83.3% versus 40%) and had more severe anemia (63.3% versus 36.7%). Conclusions: Splenectomy in transfusion-dependent thalassemia improves hemoglobin and blood counts but does not reduce iron overload, highlighting the need for continued monitoring and management.