Makindo Medical Notes.com |
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| Cause | Clinical Indications | Post-Operative Guidance |
|---|---|---|
| Trauma | Splenic rupture due to blunt abdominal trauma (e.g., motor vehicle accidents, sports injuries). | Monitor for signs of haemorrhage, provide immunizations (e.g., pneumococcal, meningococcal, Haemophilus influenzae type b), and educate on infection risk and the need for prompt antibiotic use for febrile illness. |
| Hematological Disorders | Hereditary spherocytosis, autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura (ITP), thalassemia, sickle cell disease (for splenic sequestration crisis). | Long-term prophylactic antibiotics (especially in children), regular immunizations, and patient education on recognizing symptoms of infection. Lifelong follow-up for potential complications like thrombosis and sepsis. |
| Splenic Neoplasms | Primary or metastatic tumours of the spleen, such as lymphoma or splenic angiosarcoma. | Regular follow-up with oncology, post-splenectomy vaccinations, and monitoring for any signs of infection or recurrence. Consideration of chaemotherapy or radiotherapy if indicated. |
| Infectious Diseases | Splenic abscess, granulomatous diseases (e.g., tuberculosis, sarcoidosis), or chronic infections unresponsive to medical therapy. | Comprehensive infection prophylaxis with vaccinations, possible long-term antibiotics, and regular follow-up to monitor immune status and potential recurrence. |
| Portal Hypertension | Hypersplenism secondary to liver cirrhosis or portal vein thrombosis. | Management of underlying liver disease, regular follow-up with hepatology, and monitoring for signs of portal hypertension recurrence. Post-splenectomy vaccines and infection prevention measures are critical. |
| Immune Thrombocytopenic Purpura (ITP) | Refractory ITP not responsive to corticosteroids or immunoglobulins. | Regular platelet count monitoring, post-splenectomy immunizations, and awareness of increased risk of infections and thrombosis. Possible need for additional immunosuppressive therapy. |
| Hypersplenism | Overactivity of the spleen leading to pancytopenia, commonly associated with conditions like cirrhosis or lymphoma. | Post-splenectomy prophylaxis against infections, regular blood count monitoring, and management of the underlying condition contributing to hypersplenism. Lifelong follow-up is essential. |
| Cysts or Benign Tumours | Large or symptomatic splenic cysts, benign tumours causing discomfort or risk of rupture. | Ensure complete removal of the lesion, regular follow-up imaging, and standard post-splenectomy care including vaccinations and infection risk management. |
| Sickle Cell Disease | Splenic sequestration crisis or functional asplenia due to repeated infarctions. | Immunizations, regular prophylactic antibiotics, patient education on infection risks, and monitoring for other complications related to sickle cell disease. Consideration for hydroxyurea therapy or other sickle cell-specific treatments. |
Post-splenectomy patients are at increased risk of infections, particularly from encapsulated bacteria. The following guidance outlines the standard care and preventive measures recommended in the UK: