Postsplenectomy Sepsis

• • 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

Epidemiology

• • 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

Symptoms and Signs

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

Laboratory Findings

• • Leukocytosis

• • 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

Rule Out

• • Other causes of sepsis

• • CBC

  • Blood cultures

When to Admit

• • All confirmed or suspected cases

• • Antibiotics

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

Surgery

Indications

• • None

Medications

• • Antibiotics

Complications

• • Disseminated intravascular coagulation

Prognosis

• • Improved with early recognition and aggressive treatment

Prevention

• • Preoperative vaccination against Pneumococcae and H influenzae type b

  • Prophylactic ampicillin (< age 6)

References