Makindo Medical Notes.com

By far the most common is Streptococcus pneumoniae, which can cause life-threatening infection. Lifelong Penicillin is taken.

Indications for Splenectomy

• Trauma
• Hereditary spherocytosis
• Idiopathic thrombocytopenic purpura
• Myelofibrosis as grossly enlarged.

Medical causes of Hyposplenism

• Sickle cell anaemia
• Coeliac disease
• Blood film mimics post splenectomy

Following splenectomy a person is at risk of

• Streptococcus pneumoniae
• Haemophilus influenzae
• Neisseria meningitidis
• Escherichia coli
• Pseudomonas aeruginosa.

Post splenectomy blood films

• Acanthocytes (spiky red cells)
• Target cells (like an archery target)
• Pappenheimer bodies (iron granules)
• Howell–Jolly bodies (nuclear DNA fragments)

Risks of Hyposplenism

• Overwhelming post-splenectomy infection (OPSI) is the most feared complication of hyposplenism.
• Risk of overwhelming pneumococcal sepsis

Prevention of Post Splenectomy/Hyposplenic infection

• Pneumococcal vaccination with pneumococcal conjugate vaccine is more effective, because it utilizes a T cell dependent mechanism, and should be the preferred vaccine in these circumstances. Check check adequacy of antibody response and repeat antibody levels at 5 years post vaccination and give booster doses if appropriate.
• Promptly and aggressive treatment of pneumococcal sepsis
• Meningococcal conjugate (ACWY) series and monovalent meningococcal serogroup B vaccine series.
• Usually Pneumococcal but other encapsulated bacteria e.g.Haemophilus influenzae type B and Neisseria meningitidis and protozoa have been reported.
• Life-long prophylactic antibiotic therapy, e.g. penicillin V 250 mg BD
• Mortality rate due to Strep. pneumoniae is 50% despite treatment
• Increased risk for vascular, autoimmune and thrombotic diseases and they may

Organisms to know in hyposplenic patients

• Streptococcus pneumoniae (>80%).
• Haemophilus influenzae type B.
• Neisseria meningitidis.
• Malaria (mosquitos)
• Babesiosis (tick bites)
• Capnocytophaga canimorsus (dog bites)