Post-Splenectomy
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Introduction
The Case of...
a simple case introducing clincial presentation and calling for a differential diagnosis to get students thinking.
Causes and Risk Factors
Desipte its many functions, the loss of a spleen has a single major clinical manifestation - increased susceptibility to disseminated infection by encapsulated bacteria. This is likely due to reduced filtering and antibody production functions of the spleen.
Pathogens that are particularly dangerous include:
- Streptococcus pneumoniae
- Haemophilus influenzae
- Neisseria meningitidis
- Escherichia coli
- Pseudomonas aeruginosa
- Capnocytophagia canimorsus
- group B Streptococci
- Enterococcus spp
- Ehrlichia spp
- Plasmodium spp
Other complications include:
- sepsis
- left lower lobe lung atelectasis
- subphrenic abscess
- pancreatitis
- anisocytosis, poikilocytosis, Howell-Jolly and Pappenheimer bodies, nucleated RBCs
- thrombocytosis
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Differential Diagnosis
Treatments
Immunizations are critical for patients after splenectomy. These include:
- pneumonoccal, with boosters every 5-10 years, as dictated by titres
- H influenzae type B; need for booster is unknown
- meniningococcus serogroup C
- influenza annually
Various countries offer different advice re: prophylactic antibiotics; in the absence of systematic evidence, it is reasonable to consider penicillin or eryhtromycin.
Patients should watch for signs of febrile illness and have a supply of antibiotics at home in case of infection.
Consequences and Course
Resources and References
Newland et al. 2005. Preventing severe infection after splenectomy. BMJ. 331(7514):417.
Topic Development
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