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  • • Increased risk of bacteremia and sepsis following splenectomy because of failure to clear encapsulated bacteria

    • Risk is greatest in children (especially in the first 2 years after surgery) and those undergoing splenectomy for hematologic disorders

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Epidemiology

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  • • Persons are more susceptible to fulminant bacteremia after splenectomy as a result of:

    • -Decreased clearance of encapsulated bacteria from the blood

      -Decreased levels of IgM

      -Decreased opsonic activity

    • The risk of fatal sepsis is lower when splenectomy performed for trauma than for hematologic disorders, probably due to autotransplantation

    • There is a low risk of infection even in otherwise normal adults

    • Most of these infections occur after the first year, and nearly 50% occur more than 5 years after splenectomy

    S pneumoniae, H influenzae, and meningococci are the most common pathogens

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Symptoms and Signs

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  • • Mild, nonspecific symptoms are followed by high fever and shock from sepsis, which may rapidly lead to death

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Laboratory Findings

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  • • Leukocytosis

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  • • Awareness of this fatal complication has led to efforts to avoid splenectomy or to perform partial splenectomy or splenic repair for ruptured spleens to maintain adequate splenic function

    • Splenic autotransplantation may also achieve partial restoration of splenic function after splenectomy

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Rule Out

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  • • Other causes of sepsis

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  • • CBC

    • Blood cultures

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When to Admit

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  • • All confirmed or suspected cases

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  • • Antibiotics

    • Splenectomy should be deferred until age 6 unless the hematologic problem is especially severe

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Surgery

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Indications

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  • • None

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Medications

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  • • Antibiotics

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Complications

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  • • Disseminated intravascular coagulation

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Prognosis

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  • • Improved with early recognition and aggressive treatment

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Prevention

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  • • Preoperative vaccination against Pneumococcae and H influenzae type b

    • Prophylactic ampicillin (< age 6)

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References

Okabayashi T et al: Overwhelming postsplenectomy infection syndrome in adults: a clinically preventable disease. World J Gastroenterol 2008;14:176.  [PubMed: 18186551]
Price VE et al: The prevention and management of infections in children with asplenia or hyposplenia. Infect Dis Clin North Am 2007;21:697.  [PubMed: 17826619]
Shatz DV et al: Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma-Injury Inf & Crit Care 2002;53:950.  [PubMed: 12435949]
Shatz DV et al: Antibody responses in postsplenectomy trauma patients receiving the 23-valent pneumococcal polysaccharide vaccine at 14 versus 28 days postoperatively. J Trauma-Injury Inf & Crit Care 2002;53:1037.  [PubMed: 12478024]
Spelman D et al: Guidelines for the prevention of sepsis in asplenic and hyposplenic patients. Intern Med J 2008;38:349.  [PubMed: 18284463]

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