The Splenectomy Paradox in Thalassemia: Reduced Transfusion Requirements vs. Accelerated Hepatic Fibrogenesis

Rationale and Major Conclusions Splenectomy is a conventional surgical intervention in transfusion-dependent beta thalassaemia (TDT) to manage symptomatic hypersplenism and reduce annual blood transfusion requirements. While the procedure successfully reduces the immediate volume of required transfusions, it fundamentally alters the ferrokinetic profile of the patient by removing a secondary storage reservoir for iron. Our study demonstrates that despite lower transfusion requirements, splenectomy is independently associated with a significant and clinically relevant increase in liver stiffness measurements (LSM), suggesting that the loss of the splenic "iron buffer" may accelerate hepatic fibrogenesis. These findings highlight a critical need for clinicians to prioritize medical management of hypersplenism over surgical intervention when possible and to implement rigorous hepatic monitoring for those who have already undergone the procedure.