Operative splenectomy for treatment of homozygous thalassemia major in Afghan children at a US military hospital.

Afghanistan is a war-ravaged country surrounded by mountainous terrain. Due to the geography and harsh living conditions, people have intermarried among tribes for centuries. The right familial combinations can cause manifestations of genetic linked diseases. Thalassemia major is one of these genetic diseases that are prevalent throughout southwest Asia and Africa. This condition is so severe that if left untreated, many patients die before their fifth birthday. Modern treatments in developed countries are not available in remote regions of Afghanistan. Frequent blood transfusions and surgical removal of enlarged spleens are the only options to improve life expectancy and quality of life. US military surgical hospitals and teams frequently encountered these patients and provided surgical treatment. Overall, surgical treatment of hypersplenism due to thalassemia major in this austere environment was highly successful. This article discusses the preoperative plan, intraoperative management, and postoperative care provided to 45 infants and children who underwent open splenectomy at a US military forward operating field hospital in Afghanistan.