asplenism

Introduction

Asplenism is the disorder that occurs after splenectomy, whether by surgical procedure or autosplenectomy.

Etiology

• autosplenectomy
  • sickle cell disease
• surgical procedure

Pathology

• no splenic macrophages to remove microorganisms from systemic circulation
• inadequate antibody responses to polysaccharide antigens

Complications

• infections due to encapsulated organisms
  • Streptococcus pneumonia (70% of infections)
  • Haemophilus influenzae
  • Neisseria meningitidis
  • Capnocytophaga canimorsus (DF-2)
  • Klebsiella species
  • Vibrio vulnificans
  • Babesia
• 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
• Waterhouse-Friderichsen syndrome

Management

• vaccination against encapulated organisms
  • pneumonia vaccination
    • PCV13 followed by PPSV23 in 8 weeks
      • minimum acceptable interval between PCV13 & PPSV23 is 8 weeks
    • administration of a 2nd dose of PPSV23 after 5 years & after age 65 provided 5 years has past since last PPSV23 dose
  • Haemophilus influenza B vaccine
  • meningiococcal vaccine
    • include MenHibrix for infants
• repeat immunization until antibody response is adequate
• booster immunization needed every 3-5 years
• chronic, prophylactic antibiotic therapy is beneficial for children until 2 years of age, but is not indicated for older children or adults
• influenza virus vaccine

More general terms

• immunodeficiency; immunodeficiency syndrome
• chronic immunologic disease
• splenic disease

Additional terms

• spleen
• splenectomy