Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury

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

doi:10.1016/j.injury.2021.09.020

Cited by 16 publications

(17 citation statements)

References 37 publications

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“…The results raise the question as to whether blanket policies for vaccination and/or antimicrobial prophylaxis, triggered by the detection of altered red cell morphology in the first few months post splenic artery embolisation in trauma, are overtreating. This has been further supported by recent publications 5,15 …”

Section: Discussionsupporting

confidence: 81%

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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

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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.

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Section: Discussionsupporting

confidence: 81%

“…This has been further supported by recent publications. 5,15 Whilst the decrease in volume with distal embolisation was statistically significant, the decrease in volume was not associated with altered red cell morphology. There were no cases of distal embolisation resulting in altered red cell morphology.…”

Section: Discussionmentioning

confidence: 94%

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

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“…In current literature, it is still controversial if NOM of splenic injuries, with or without SAE, can be associated with impairment of splenic role in immunocompetence, so it has not been clarified if these patients should be immunized. Some authors argued that immune function might be preserved following SAE [ 136 ], and, in 2015, the systematic review by Schimmer et al [ 137 ] concluded that none of the 12 included studies reported an OPSI after SAE. Eleven studies found a preserved splenic function after SAE in adults and children.…”

Section: Methodsmentioning

confidence: 99%

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

et al. 2022

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Background In 2017, the World Society of Emergency Surgery published its guidelines for the management of adult and pediatric patients with splenic trauma. Several issues regarding the follow-up of patients with splenic injuries treated with NOM remained unsolved. Methods Using a modified Delphi method, we sought to explore ongoing areas of controversy in the NOM of splenic trauma and reach a consensus among a group of 48 international experts from five continents (Africa, Europe, Asia, Oceania, America) concerning optimal follow-up strategies in patients with splenic injuries treated with NOM. Results Consensus was reached on eleven clinical research questions and 28 recommendations with an agreement rate ≥ 80%. Mobilization after 24 h in low-grade splenic trauma patients (WSES Class I, AAST Grades I–II) was suggested, while in patients with high-grade splenic injuries (WSES Classes II–III, AAST Grades III–V), if no other contraindications to early mobilization exist, safe mobilization of the patient when three successive hemoglobins 8 h apart after the first are within 10% of each other was considered safe according to the panel. The panel suggests adult patients to be admitted to hospital for 1 day (for low-grade splenic injuries—WSES Class I, AAST Grades I–II) to 3 days (for high-grade splenic injuries—WSES Classes II–III, AAST Grades III–V), with those with high-grade injuries requiring admission to a monitored setting. In the absence of specific complications, the panel suggests DVT and VTE prophylaxis with LMWH to be started within 48–72 h from hospital admission. The panel suggests splenic artery embolization (SAE) as the first-line intervention in patients with hemodynamic stability and arterial blush on CT scan, irrespective of injury grade. Regarding patients with WSES Class II blunt splenic injuries (AAST Grade III) without contrast extravasation, a low threshold for SAE has been suggested in the presence of risk factors for NOM failure. The panel also suggested angiography and eventual SAE in all hemodynamically stable adult patients with WSES Class III injuries (AAST Grades IV–V), even in the absence of CT blush, especially when concomitant surgery that requires change of position is needed. Follow-up imaging with contrast-enhanced ultrasound/CT scan in 48–72 h post-admission of trauma in splenic injuries WSES Class II (AAST Grade III) or higher treated with NOM was considered the best strategy for timely detection of vascular complications. Conclusion This consensus document could help guide future prospective studies aiming at validating the suggested strategies through the implementation of prospective trauma databases and the subsequent production of internationally endorsed guidelines on the issue.

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“…Immunoglobulins are important manifestations of humoral immunity. Spleen, as the largest peripheral immune organ in poultry, is an important organ for dominating immune responses and can produce immunoglobulins, such as immunoglobulin A (IgA), immunoglobulin G (IgG), and immunoglobulin M (IgM) [ 17 ]. The immunoglobulins play an important role in neutralizing toxins, bacteria, or viruses, regulating and activating complement, and they are also important indicators for immune function [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Selenium-Enriched Yeast Relieves Hexavalent Chromium Toxicity by Inhibiting NF-κB Signaling Pathway in Broiler Spleens

Zhao

Hao

Zhang

et al. 2022

Animals

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This study was conducted to investigate the molecular mechanisms of selenium (Se) antagonism of hexavalent chromium (Cr6+)-induced toxicity. Potassium dichromate (K2Cr2O7) and selenium-enriched yeast (SeY) were used to construct the single Cr6+ and combined Se/Cr6+ exposure broiler models, and then the broilers were randomly divided into four groups (C group, Se group, Se/Cr6+ group, and Cr6+ group). After a 42-day experiment, the spleen tissues of broilers were excised and weighted. The antagonistic mechanisms of Se and Cr6+ were evaluated using histopathological assessment, serum biochemical tests, oxidative stress kits, ELISA, qPCR, and Western blotting. On the whole, there were no significant changes between the C and Se groups. The spleen organ index in the Cr6+ group was significantly decreased, but SeY increased spleen organ index to a certain extent. The levels of SOD and GSH were reduced, and the MDA content was elevated by Cr6+; however, these changes were mitigated by Se/Cr6+ exposure. Importantly, Cr6+ exposure induced a series of histopathological injuries in broiler spleen tissues, while these symptoms were significantly relieved in the Se/Cr6+group. Furthermore, Cr6+ significantly decreased the levels of T-globulin, IgA, IgM, and IgG in serum. Contrarily, dramatically more T-globulin IgA, IgM, and IgG were found in the Se/Cr6+group than in the Cr6+ group. Revealed by the results of qPCR and WB, the expressions of NF-κB, IκBα, and p-IκBα were upregulated in Cr6+ groups, while they were downregulated in Se/Cr6+ group compared to that in Cr6+ group. Besides IFN-γ and IL-2, the expressions of pro-inflammatory cytokines were significantly increased by Cr6+ exposure, but the SeY supplement relived the expression levels mediated by Cr6+ exposure. In conclusion, our findings suggest SeY has biological activity that can protect broiler spleens from immunosuppression and inflammation induced by Cr6+, and we speculate that the NF-κB signaling pathway is one of its mechanisms.

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Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury

Cited by 16 publications

References 37 publications

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

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

Follow-up strategies for patients with splenic trauma managed non-operatively: the 2022 World Society of Emergency Surgery consensus document

Selenium-Enriched Yeast Relieves Hexavalent Chromium Toxicity by Inhibiting NF-κB Signaling Pathway in Broiler Spleens

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