Asplenic-hyposplenic Overwhelming Sepsis: Postsplenectomy Sepsis Revisited

Abstract

Absence of the spleen or splenic function predisposes individuals to risk of overwhelming infection. These infections are most often due to encapsulated organisms, especially pneumococcus, Haemophilus influenzae type b, and meningococcus, but any bacterial agent may cause the rapid onset of septicemia, meningitis, pneumonia, and shock characteristic of the asplenic-hyposplenic condition. The risk is greatest in infants and young children, but asplenic-hyposplenic adults also have an increased risk of infection. Prophylactic antibiotics and immunization with polyvalent pneumococcal, H. influenzae type b, and meningococcal vaccines have reduced the incidence of infections in asplenic-hyposplenic individuals, but even these measures have not eliminated the risk. Surgeons have adopted techniques to save as much splenic tissue as possible and some splenic functions, such as pitting red cells, have been preserved, but conservative surgery has not provided total protection against overwhelming infection. Therapies designed to interrupt the cascade of overwhelming sepsis have not yet been successful. In those cases in which the spleen is surgically removed, the underlying disease or condition leading to splenectomy influences the risk of sepsis. Splenectomy incidental to other operations, such as gastrectomy, results in the lowest risk for overwhelming infection, but this is still some 35-fold greater than the risk for overwhelming infections in the general population. In increasing order of risk, the other main indications for surgical removal of the spleen are idiopathic thrombocytopenia purpura, trauma, transplantation procedures, hereditary spherocytosis, staging Hodgkin's disease, portal hypertension with hypersplenism, and thalassemia. Pathologists should comment on the risk of overwhelming sepsis when spleens are processed as surgical specimens, and should carefully weigh all splenic tissue, including accessory spleens and splenic implants (splenosis), in autopsy cases with and without overwhelming sepsis.

Blood Utilization in Children Managed Non-Operatively for Blunt Solid Organ Injury

“…The immunological consequences of splenectomy [5,6] and the realization that most splenic injuries stop bleeding spontaneously in the vast majority of cases created the impetus for nonoperative management, which is now the standard of care [7]. The current recommendation of bed rest equaling 1 day plus the grade of injury has recently been reviewed, and an attenuated protocol has been recommended for hemodynamically stable patients to facilitate concise utilization of health care resources [8].…”

Long-term following-up of viability of spleen autotransplants in the Beagle canine model

“…Its functions can be divided into four main groups, such as filtration, immunological, storage and haemopoietic functions. Recent studies have showed its role in lipid-metabolism, too [1][2][3][4][5][6] .…”

“…In the clinical practice the early and late complications following splenectomy have been known for a long time 2,7,8 , but the explanation for the late complications was given only by recent research on spleen surgery and spleen-sparing operations 8 .…”

“…This fulminant sepsis was firstly described by King and Shumacher 7 published in 1952. In spite of the modern treatment protocols the mortality of OPSI syndrome is still very high 2,11,[12][13][14][15] .…”

Effect of esophagogastric devascularization with splenectomy on schistossomal portal hypertension patients' immunity

“…Prophylactic antibiotics and immunization with polyvalent Pneumococcal, H. infl uenzae type b, and Meningococcal vaccines have reduced the incidence of infections in asplenic individuals, but even these measures have not eliminated the risk. Therapies designed to interrupt the cascade of overwhelming sepsis have not yet been successful (13,19,23,30,37) . Since 1985, we had performed at minimum 250 EGDS in "Santa Casa" Medical School, Surgery Department, São Paulo, SP, Brazil.…”