Haematological Parameter Changes in Per-operative Early Ligation of Splenic Artery during Splenectomy in Children with Hypersplenism

Abstract Background: Hypersplenism is a clinical syndrome characterized by splenomegaly and reduction in the number of one or more types of blood cells and improvement of cytopenias after splenectomy. Splenic function accelerates and even sequestrates up to 90% of body platelets and 40-50% of the Red cellsresulting in increased demand of blood and blood product transfusion. Purpose: To evaluate the changes of blood components per-operatively after early splenic artery ligation during splenectomy in children with hypersplenism. Methods: This quasi experimental study was conducted at the Department of Paediatric Surgery, BSMMU, Dhaka, Bangladesh without interrupting standard care practiced in the department during March 2021 to August 2022. Proper clinical history, physical examinations, initial investigation reports and pre-operative blood transfusion data were recorded in a standard data sheet. Per-operative blood samples just prior to splenic artery ligation and at 5th & 30th minutes after arterial ligation before ligation of splenic vein were collected from peripheral venous blood. Samples were analyzed in the department of Laboratory Medicine, BSMMU. Statistical analyses of the result were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS). Results: Total 16 patients undergoing splenectomy was included and mean age was 9.12 ± 3.25 years and range was 6-14 years. No blood and blood products were transfused in these patients up to 7 days prior to surgery. At 5th and 30th minutes after splenic artery ligation the mean haemoglobin change was 0.69 ± 0.85 gm/dl and 1.53 ± 2.06gm/dl, mean haematocrit change was 1.85 ± 2.84 % and 4.36 ± 6.70 %, mean RBC count change was 0.27 ± 0.40 x 1012/L and 0.58 ± 0.94 x 1012/L, mean TLC change was 7.49 ± 5.98 x 109/L and 7.91 ± 6.26 x 109/L, mean platelet count change was 46.44 ± 49.3 x 109/L and 86.7 ± 86.4 x 109/L. All the parameters analysed depicted significant gain of blood parameters proportionate to allocated time after splenic artery ligation. Conclusion: Early splenic artery ligation during splenectomy in hypersplenism results in auto-transfusion and significant increase of different haematological parameters (Haemoglobin, RBC, Haematocrit, Total leukocytes and Platelets) and helps in reducing blood and blood products transfusion in peri-operative period.