Symptomatic hemolytic anemia Presence of gallstones Large reduction in exercise tolerance Growth retardation Skeletal changes or leg ulcers due to HS Extramedullary hematopoietic tumors Vascular compromise of vital organs in older patients Splenic infarct with pain or early satiety from splenomegaly
Consider delaying splenectomy until > 6 years old if possible.
Guideline recommendations:
Recommendations regarding splenectomy in hereditary hemolytic anemias by Splenectomy in Rare Anemias Study Group (2017):
2012 British Committee Standards in Haematology (BCSH) expert guideline on diagnosis of hereditary spherocytosis: