Splenectomy versus conservative management for acute sequestration crises in people with sickle cell disease

Abstract

Background: Acute splenic sequestration crises are a complication of sickle cell disease, with high mortality rates and frequent recurrence in survivors of first attacks. Splenectomy and blood transfusion, with their consequences, are the mainstay of long-term management used in different parts of the world. This is a 2015 update of a Cochrane review first published in 2002, and previously updated in 2013. Objectives: To assess whether splenectomy (total or partial), to prevent acute splenic sequestration crises in people with sickle cell disease, improved survival and decreased morbidity in people with sickle cell disease, as compared with regular blood transfusions. Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises of references identified from comprehensive electronic database searches and handsearching relevant journals and abstract books of conference proceedings. Additional trials were sought from the reference lists of the trials and reviews identified by the search strategy. Date of the most recent search: 10 June 2015. Selection criteria: All randomized or quasi-randomized controlled trials comparing splenectomy (total or partial) to prevent recurrence of acute splenic sequestration crises with no treatment or blood transfusions in people with sickle cell disease. Data collection and analysis: No trials of splenectomy for acute splenic sequestration were found. Main results: No trials of splenectomy for acute splenic sequestration were found. Authors' conclusions: Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in people with sickle cell disease. There is a need for a well-designed, adequately-powered, randomized controlled trial to assess the benefits and risks of splenectomy compared to transfusion programmes, as a means of improving survival and decreasing mortality from acute splenic sequestration in people with sickle cell disease. There are no trials included in the review and we have not identified any relevant trials up to June 2015. We will continue to run searches to identify any potentially relevant trals; however, we do not plan to update other sections of the review until new trials are published.