Immune Function After Splenic Artery Embolization for Blunt Trauma: Long-Term Assessment of CD27+ IgM B-Cell Levels

Lukies, Matthew; Zia, Adil; Kavnoudias, Helen; Bosco, Julian J.; Narita, Callum; Lee, Robin; Joseph, Tim; Clements, Warren

doi:10.1016/j.jvir.2022.02.004

Cited by 6 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The vaccination rates are lower in these patients, who appear to have a lower rate of infection, but larger studies and more evidence are required 25 . Sixteen patients followed up for 4.7–12.8 years after embolisation all had evidence of IgM memory B cells, splenic tissue visible on ultrasound and no history of severe infections, further supporting the proposal that vaccinations are not mandatory 26 . However, this was a small study and measurement of IgM memory B cells is not a validated method for assessment of immune function.…”

Section: Education and Informationmentioning

confidence: 79%

“…25 Sixteen patients followed up for 4.7-12.8 years after embolisation all had evidence of IgM memory B cells, splenic tissue visible on ultrasound and no history of severe infections, further supporting the proposal that vaccinations are not mandatory. 26 However, this was a small study and measurement of IgM memory B cells is not a validated method for assessment of immune function. Decisions about vaccination in these patients should be made on an individual basis, with vaccination being considered for patients who have other reasons for immune dysfunction.…”

Section: E Duc At Ion a N D I N For M At Ionmentioning

confidence: 98%

See 1 more Smart Citation

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Ladhani,

Fernandes,

Garg

et al. 2024

Br J Haematol

View full text Add to dashboard Cite

SummaryGuidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non‐infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti‐microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.

show abstract

Section: Education and Informationmentioning

confidence: 79%

Section: E Duc At Ion a N D I N For M At Ionmentioning

confidence: 98%

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Ladhani,

Fernandes,

Garg

et al. 2024

Br J Haematol

View full text Add to dashboard Cite

show abstract

“…11 Both these cohorts predominantly underwent proximal embolisation. 4,11 This study differed with 73.3% of patients undergoing only distal embolisation. A further difference was that the clinical pathway utilised in this study allows for observation of high-grade splenic injuries, 10 whereas other published studies have relied on protocols based on routine angioembolisation.…”

Section: Discussionmentioning

confidence: 99%

“…One study had no significant change in splenic volume with a mean follow up of 1.9 years for their trauma cohort 4 . Another followed a cohort of 17 patients out to 7.7 years and showed preserved spleen function as measured by IgM memory B Cells, in spite of an overall reduction in splenic volume 11 . Both these cohorts predominantly underwent proximal embolisation 4,11 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A retrospective multi‐centre study of splenic volumes measured by CT following splenic artery angioembolisation for high‐grade blunt splenic injuries in adults

et al. 2022

View full text Add to dashboard Cite

Introduction: Splenic artery embolisation is a recognised modality in the management of high grade blunt splenic injury. The impact of embolisation on the spleen in terms of volume and function remains unclear. This results in a lack of clarity regarding post embolisation vaccination policy. Methods: This was a two-centre, retrospective observational study over a 24month period involving all patients who underwent splenic artery embolisation for high grade blunt splenic trauma (AAST grades III-V). Splenic volumes were calculated from an initial CT and a repeat CT at 6 months post embolisation. Subgroup analysis was performed analysing the location of embolisation, AAST grading, and evidence of splenic dysfunction as defined by the presence of altered red cell morphology. Results: Thirty patients achieved successful splenic salvage with angioembolisation. Mean volume loss was 44.14 cm 3 (P = 0.038), with decreased volumes for distal embolisation and increased volumes for proximal embolisation. Three patients had altered red cell morphology; two demonstrated recovery at 6 months, with the third lost to follow up. There were significant associations between, initial splenic volume, AAST grade of injury, and altered red cell morphology. There was no significant association between location of embolisation, initial splenic volumes, or percentage volume change. Conclusion: This study demonstrated a statistically significant change in splenic volume post angioembolisation in trauma, which was associated with AAST grading but not location of embolisation. The low rate of altered red cell morphology appears transient.

show abstract

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Lukies,

Clements

2023

UEG Journal

Self Cite

View full text Add to dashboard Cite

BackgroundSplenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low‐grade injuries or with splenectomy for high‐grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation.MethodsA systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality.ResultsThe 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59–70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81).ConclusionsSplenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.

show abstract

Immune Function After Splenic Artery Embolization for Blunt Trauma: Long-Term Assessment of CD27+ IgM B-Cell Levels

Cited by 6 publications

References 15 publications

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

A retrospective multi‐centre study of splenic volumes measured by CT following splenic artery angioembolisation for high‐grade blunt splenic injuries in adults

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Contact Info

Product

Resources

About