Hemostasis in children with hemolysis undergoing splenectomy

Introduction:Patients with hemolysis are at high risk of thrombosis after splenectomy.However, some patients may also be vulnerable to bleeding.The aim of this study was to estimate the hemostasis system in patients before and after splenectomy.Methodology: Clotting times (APTT,PT), fibrinogen, ATIII, proteins C and S, von Willebrand Factor(vWF:Ag) and D-dimer levels, platelet aggregometry with ADP, collagen, adrenaline, thrombin, and global hemostasis assay (thrombodynamics (TD), thromboelastography (TEG) in two points before and 3-5 days after splenectomy were used to asses the hemostatic state in patients.Twelve children (5 boys and 7 girls, age: 8-17 yrs) with hereditary spherocytosis(HS) and 2 boys (9 and 13 yrs) with autoimmune hemolytic anemia (AIHA) against the background of acute lymphoblastic leukemia(ALL) were enrolled. Results:We divide patients into 2 groups: with and without hemorrhage.Two patients with HS and one patient with AIHA(ALL) had bleeding after surgery.Clotting times and aggregometry were in normal in all patients before and after surgery.PLT levels (257127 vs 432221*109/l) were increased in most patients after surgery, so do fibrinogen (2,010,69 vs 4,111,74g/l, p<0.01) and D-dimer (9046 vs 12402331ng/ml, p<0.01) levels in all patients.We do not reveal the statistically significant changes in PC, ATIII levels, but some patients had lower PS levels.vWF:Ag(16139 vs 16856%in 1st group, 11350 vs 16688% in 2nd group).