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Splenectomy and Hyposplenism
⚠️ The spleen is essential for clearing encapsulated bacteria. Loss of function → risk of overwhelming post-splenectomy infection (OPSI). 🦠 Most important pathogen: Streptococcus pneumoniae. 💊 Antibiotic prophylaxis: recommended for all initially, with duration guided by risk.
🔪 Indications for Splenectomy
- Trauma (most common in UK)
- Hereditary spherocytosis
- Immune thrombocytopenia (ITP)
- Myelofibrosis with massive splenomegaly
- Selected haematological malignancies
🧬 Medical Causes of Hyposplenism
- Sickle cell disease (functional asplenia)
- Coeliac disease (functional hyposplenism)
- Inflammatory bowel disease
🦠 Infection Risk
- Encapsulated organisms:
- Streptococcus pneumoniae (most important)
- Haemophilus influenzae type b
- Neisseria meningitidis
- Other risks:
- Capnocytophaga canimorsus (dog bites)
- Malaria, babesiosis
🩻 Blood Film Findings
- Howell–Jolly bodies
- Target cells 🎯
- Pappenheimer bodies
- Thrombocytosis
⚠️ Risks
- OPSI: rapid sepsis with high mortality (up to 50%)
- ↑ Risk of thrombosis
- ↑ Risk from intra-erythrocytic parasites (e.g. malaria)
🛡 Prevention
- Vaccination:
- Pneumococcal: PCV → PPV23 (≥8 weeks later), repeat PPV23 every 5 years
- Meningococcal: MenACWY + MenB
- Hib vaccine
- Annual influenza + COVID vaccination
- Antibiotic prophylaxis:
- Phenoxymethylpenicillin (penicillin V)
- Children: lifelong
- Adults: ≥2 years post-splenectomy; lifelong if high risk
- Emergency planning:
- Carry medical alert (“asplenia card”)
- Have rescue antibiotics at home
- Start immediately with fever and seek urgent care
- Travel advice:
- Malaria prophylaxis if endemic travel
- Prompt antibiotics after animal bites (e.g. co-amoxiclav)
📚 References
- UKHSA (Green Book): Immunisation of individuals with asplenia
- British Society for Haematology: Splenectomy guidelines
- NICE CKS: Asplenia and hyposplenism
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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