American Board of Internal Medicine (ABIM) Certification Practice Exam

Why might partial splenectomy be considered in children with hereditary spherocytosis?

1. It eliminates the need for vaccinations

2. It preserves splenic immune function

3. It is less invasive than total splenectomy

4. It maximizes iron absorption

The correct answer is: It preserves splenic immune function

Partial splenectomy may be considered in children with hereditary spherocytosis primarily because it helps preserve splenic immune function. The spleen plays a crucial role in immune responses, particularly in filtering blood and producing antibodies against specific pathogens. In hereditary spherocytosis, where patients are at risk for infections due to the destruction of spherocytes, maintaining some splenic function can be important. By performing a partial splenectomy, surgeons can remove enough of the spleen to alleviate symptoms, such as anemia or splenomegaly, while still retaining enough tissue to provide some degree of immune protection against infections. Maintaining this immune function is especially critical for children, as they are typically at higher risk for infections due to the decreased capacity of their spleens. Therefore, the decision to opt for partial splenectomy is influenced by the desire to balance the management of hereditary spherocytosis with the ongoing protection against infections that the spleen provides. This surgical approach can help mitigate the potential risks associated with total splenectomy, such as overwhelming post-splenectomy infection (OPSI), while still addressing the hematological concerns related to the condition.