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asplenism

Asplenism is the disorder that occurs after splenectomy, whether by surgical procedure or autosplenectomy. Etiology: 1) autosplenectomy - sickle cell disease 2) surgical procedure Pathology: 1) no splenic macrophages to remove microorganisms from systemic circulation 2) inadequate antibody responses to polysaccharide antigens Complications: 1) infections due to encapsulated organisms a) Streptococcus pneumonia (70% of infections) b) Haemophilus influenzae c) Neisseria meningitidis d) Capnocytophaga canimorsus (DF-2) e) Klebsiella species f) Vibrio vulnificans g) Babesia 2) patients with splenectomy for hereditary spherocytosis, Hodgkin's disease or thrombocytopenia appear to be at greater risk of sepsis than those with splenectomy due to trauma 3) Waterhouse-Friderichsen syndrome Management: 1) vaccination against encapulated organisms a) pneumonia vaccination - PCV13 followed by PPSV23 in 8 weeks [1,2] - minimum acceptable interval between PCV13 & PPSV23 is 8 weeks [1] - administration of a 2nd dose of PPSV23 after 5 years & after age 65 provided 5 years has past since last PPSV23 dose [1] b) Haemophilus influenza B vaccine c) meningiococcal vaccine - include MenHibrix for infants 2) repeat immunization until antibody response is adequate 3) booster immunization needed every 3-5 years 4) chronic, prophylactic antibiotic therapy is beneficial for children until 2 years of age, but is not indicated for older children or adults 5) influenza virus vaccine [4]

Related

spleen splenectomy

General

immunodeficiency; immunodeficiency syndrome chronic immunologic disease splenic disease

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 19 American College of Physicians, Philadelphia 1998, 2015, 2022
  2. Journal Watch 25(9):70-71, 2005 Musher DM, Ceasar H, Kojic EM, Musher BL, Gathe JC Jr, Romero- Steiner S, White AC Jr. Administration of protein-conjugate pneumococcal vaccine to patients who have invasive disease after splenectomy despite their having received 23-valent pneumococcal polysaccharide vaccine. J Infect Dis. 2005 Apr 1;191(7):1063-7. Epub 2005 Feb 28. PMID: 15747240
  3. Ram S, Lewis LA, Rice PA. Infections of people with complement deficiencies and patients who have undergone splenectomy. Clin Microbiol Rev. 2010 Oct;23(4):740-80 PMID: 20930072
  4. Rubin LG, Schaffner W Care of the Asplenic Patient. N Engl J Med 2014; 371:349-356. July 24, 2014 PMID: 25054718 http://www.nejm.org/doi/full/10.1056/NEJMcp1314291
  5. Splenectomy (Cleveland Clinic Foundation) http://www.clevelandclinic.org/misc/surgical/general/splenectomy.htm