An 8-year-old boy with beta-thalassemia major on regular transfusions has shown a steady rise in his annual transfusion requirement over two years, now exceeding 200 mL/kg/year compared with 120 mL/kg/year previously. The spleen extends 8 cm below the costal margin. What is the standard threshold-based indication for splenectomy in this setting?

• A Platelet count persistently below 100 x 10^9/L
• B Serum ferritin above 2500 ng/mL
• C Age above 3 years regardless of transfusion need
• D Increase in annual transfusion requirement of more than 50 percent attributable to hypersplenism ✓

Explanation

Hypersplenism raises the transfusion requirement, and a sustained increase of more than 50 percent is the conventional trigger for splenectomy, since removing the spleen lowers consumption and chelation burden. Surgery is deferred beyond age 5 whenever possible because of the lifetime risk of overwhelming infection with encapsulated organisms, requiring vaccination against pneumococcus, meningococcus, and Hib beforehand. Ferritin reflects chelation adequacy, not splenectomy timing.

Reference: Williams Hematology, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.