Funktionelle Hyposplenie nach allogener Knochenmarktransplantation: Ein Fallbericht

Abstract

Functional hyposplenia/asplenia is a severe longterm complication after allogeneic stemcell transplantation predominantly seen in patients who suffer from extensive chronic graft versus host disease (cGvHD). The risk of acquiring an overwhelming infection with encapsulated bacteria is ca. four fold increased in patients with functional hyposplenia/asplenia. Therefore follow up of patients who have received allogeneic blood stem cells (bone marrow or peripheral blood stem cells) should embrace screening for functional hyposplenia. When functional hyposplenia is diagnosed triple vaccination against streptococcus pneumonia, Haemophilus influenza type B and Meningococcus neisseria should be considered. Goldstandard in diagnosing functional hyposplenia is hepatosplenic scintigraphy. We present the case of 37 year old female in whom sonography was indicative of functional hyposplenia. The diagnosis was confirmed by scintigraphy. Sonography including color coded duplex sonography is a safe and cost saving procedure. Sensitivity, Specificity and predictive value of the following sonographic finding: a) decreasing splenic size and b) diminished or absent parenchymal blood flow are currently evaluated in a prospective study.

Howell-Jolly bodies and liver-spleen scanning for assessment of splenic filtrative function yields discordant results in renal transplant recipients

“…There is also further supporting evidence from the literature. Indeed, based on data from the literature, 55 of 90 (61.1%) patients with a presence of HJBs had an absent or small spleen, [ 1 – 3 , 10 , 11 , 13 , 16 , 18 , 19 , 21 , 22 , 24 – 27 , 29 , 32 , 33 , 35 , 36 , 41 – 45 , 49 , 50 , 52 , 54 , 55 , 57 – 59 , 61 , 62 , 66 , 68 , 69 , 71 ] , whereas only 1 of 13 (7.7%) patients with absence of HJBs had a small spleen. [ 16 , 26 , 28 , 37 , 40 , 53 , 64 , 65 ] Moreover, of 35 cases of HJBs present with normal or enlarged spleen, 9 were sickle cell anemia cases [ 1 ] and in 5, microscopic sections showed extensive splenic parenchymal replacement by tissue infiltration of the underlying disease.…”

Bacterial Pathogens Causing Pneumonia Post Hematopoietic Stem Cell Transplant: The Chronic GVHD Population

“…These complex processes result in cGVHD manifestations such as bronchiolitis or sclerodema and induce prolonged cellular and humoral immune deficits. Encapsulated bacteria, such as Streptococcus pneumoniae and Haemophilus influenzae , have been dominantly seen in this population [ 1 , 12 , 16 , 17 , 18 ]. Pneumonia in the chronic GVHD patient carries a fivefold risk for mortality [ 12 ].…”