Cord blood transplant instead of marrow

Wishing good days and health to everybody.

I am a captain on oceangoing vessels so i am not having internet all time, sorry for it.

As I heart (i men read), at the mid of 2013 there was a thal patient college girl treated permanently via cord blood transplant at USA. As far as I know, this method, is pretty much safer than marrow transplantation, and has better treatment stage for the patient.

My wife having Thal-B Major and we are planning splenectomy at April-2014.

But our doctors explain that, splenectomy has roughly 50-50 chance to reduce blood transplantation need for a Thal-B patient due to not being able to specify the destruction place of blood cells in her body, weather spleen or marrows. If they were being destroyed in her spleen the result that they expect will be like our wishes, if not the splenectomy will not work because of marrows guilt.

So, I require your suggestions before operation. Meanwhile we have a 2 year old kid and having his cord blood in a cord blood bank.

And advising everyone to keep close attention to cord blood transplantation improvements on thallasemia, i wish soon or later they will have enough trustable and easy treatments.

Thanks in advance.

Splenectomy is no longer routine for thals. It should be reserved for those where it is necessary, either because there is an over-consumption of blood annually or the spleen is enlarged to the point where rupture is a possibility. This is from the Standards of Care for Thalassemia.

4.5 Splenectomy
The use of splenectomy in thalassemia has declined in recent years.
This is partly due to a decreased prevalence of hypersplenism
in adequately transfused patients. There is also an increased
appreciation of the adverse effects of splenectomy on blood
coagulation. In general, splenectomy should be avoided unless
absolutely indicated.
Splenectomy is indicated in the transfusion-dependent patient
when hypersplenism increases blood transfusion requirement
and prevents adequate control of body iron with chelation
therapy. An enlarged spleen—without an associated increase
in transfusion requirement—is not necessarily an indication
for surgery. Patients with hypersplenism may have moderate
to enormous splenomegaly, and some degree of neutropenia or
thrombocytopenia may be present.
Annual transfusion volume exceeding 225 to 250 mL/kg per year
with packed red blood cells (hematocrit 75 percent) may indicate
the presence of hypersplenism. The volume calculation should
be corrected if the average hematocrit is less than 75 percent.
The possible development of alloantibody should also be ruled
out. Splenectomy should be avoided unless there is an inability
to maintain iron balance with optimal chelation, or if there are
clinically significant complications such as pancytopenia and
marked enlargement. Often, hypersplenism develops because of
a low pre-transfusion hemoglobin. Increasing the pre-transfusion
hemoglobin to between 9.5 and 10 may reverse hypersplenism.
If a decision to perform surgery is made, partial or full
splenectomy is the option. Partial splenectomy is a complicated
surgery utilized to preserve some splenic function. It should be
reserved for infants requiring splenectomy. Full splenectomy
can usually be performed by laparoscopic technique. However,
open procedure is necessary in cases of marked splenomegaly.
The indications for splenectomy in hemoglobin H–Constant
Spring patients are different than in beta-thalassemia disorders.
Transfusion-dependent infants with hemoglobin H–Constant
Spring respond rapidly to splenectomy but require prophylactic
anticoagulation because of a high incidence of serious thrombosis.
Patients must receive adequate immunization against Streptococcus
pneumoniae, Haemophilus influenzae type B, and Neisseria
meningitides prior to surgery. Splenectomy should be avoided
in children younger than five years because of a greater risk of
fulminant post-splenectomy sepsis.
After splenectomy, patients should receive oral penicillin
prophylaxis (250 mg twice daily) and be instructed to seek urgent
medical attention for a fever over 101º Fahrenheit.
Post-splenectomy thrombocytosis is common, and low-dose
aspirin should be given during this time. Another complication
following splenectomy is the development of a thrombophilic
state. Venous thromboembolism, more common in thalassemia
intermedia and hemoglobin H–Constant Spring, can develop
following splenectomy.
Patients should have annual echocardiographic measurement of
the pulmonary artery pressure to monitor for development of
pulmonary hypertension.

Many thanks Mr.Andy.

Splenectomy pretty much clear for me since i read your articles, in this topic and also in others. As i calculated my wife's annual transfusion volume (bearing in mind the hematocrit levels) we are at the edge, not exceeding but so close. Also her spleen sized as 180mmX90mm (she is 33 year old), so probably we will allow to splenectomy.

I am still digging and just want to see a transplant center which is able to make Cord Blood Tranfer treatment and will acknowledge their suggestions, before splenectomy. I wish your advices regarding that option, too.

Kind regards.