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Thalassemia Major
Chapter 6
Questions About Splenectomy
Should everyone with thalassemia major or thalassemia intermedia have their spleen taken out?
         No, you only need your spleen taken out if it is making your thalassemia worse.

Is splenectomy a dangerous operation
         It Carries only a small risk

Does it cause any problems, if you don't have a spleen?
         Your spleen is important to help defend your body against bacteria. If you don't have a spleen, very ocassionaly a bacterial infection can develop rapidly, so as to become life-threatning in a very few hours. Therefore, everyone who has had their spleen out should consider every infection as potentially serious. It is important to discuss this problem with your own doctor, and decide precisely what to do if you an illness with a fever.

What can we do to avoid serious infections after splenectomy?
         There are some things you can do. One is to have a "anti-pneumococcal vaccine" before spleen is taken out.
         Some doctors advice thalassemics whose spleen has been removed to take daily doses of penicillin to prevent some bacterial infection. This treatment may be recommended for a few years only, or for life.
         Other doctors see that people often forget to take penicillin tablets regualrly and they only prevent some infections anyway. There are two ways to deal with it. Some doctors prescribe an injection of long-acting penicilling once a month, but these injections are painfull. Other doctors rely on a sort of collaboration with the family. They tell them if the patient has a fever that it is not obviously just due to cold, they must go immediately to the treatment center, or to the family doctor, for an examination and further advice. (In places where it is not easy to contact or reach the center very quickly, they sometimes give the family some antibiotics to keep at home. These should be taken at once if there is a fever with no obvious explanation. and then the patient should be taken to the center.) This sytem seems to work very well. As with many other things, if you understand a risk, you can usually avoid it.

Does splenectomy causes any other problems?
         No. Blood tests shows that the number of platelets in the blood usually increases, sometime to a really high level, following splenectomy. However, there is no evidence that the increased number of platelets causes any problems.
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