<p>Post-splenectomy sepsis: preventative strategies, challenges, and solutions</p>

Abstract

Removal of the spleen had already been established as a routine technique to treat splenic trauma and other diseases affecting the spleen before the anatomy, physiology, and function of the spleen were known in the mid-twentieth century. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming post-splenectomy infection (OPSI). OPSI is a syndrome of fulminant sepsis occurring in splenectomized (asplenic) or hyposplenic individuals that is associated with high mortality and morbidity. Poorly opsonized bacteria such as encapsulated bacteria, in particular, Streptococcus pneumoniae, are often implicated in sepsis. The spleen is a reticuloendothelial organ that facilitates opsonization and phagocytosis of pathogens, in addition to cellular maintenance. Splenectomy is associated with an impairment in immunoglobulin production, antibody-mediated clearance, and phagocytosis, leading to an increased risk of infection and sepsis. Early identification of the at-risk patient, early blood cultures prior to antibiotic administration, urgent blood smears and fast pathogen-detection tests, and sepsis bundles should be utilized in these patients. Prompt management and aggressive treatment can alter the course of disease in the at-risk splenectomized patient. Overwhelming post-splenectomy infection can be prevented through vaccination, chemoprophylaxis, and patient education. This article evaluates post-splenectomy sepsis by summarizing the anatomy and function of the spleen, physiological changes after splenectomy that predispose the splenectomized patient to infection, and current management and prevention strategies.

Post-splenectomy Sepsis: A Review of the Literature

“…Splenectomy, or the surgical removal of the spleen, is usually considered a life-saving procedure in traumatized individuals, certain hematological disorders, malignant conditions, and for the sake of diagnostic purposes [10]. Globally, the incidence of splenectomy is nearly 6.4-7.1 per 100,000 people per annum, with trauma (25%) and hematological disorders (25%) being the most common culprits [5].…”

Contribution of Extramedullary Hematopoiesis to Atherosclerosis. The Spleen as a Neglected Hub of Inflammatory Cells

“…thus increasing the risk of infections (141)(142)(143)(144). Additionally, the elevated platelet counts results in thromboembolism-prone subjects with a hypercoagulable condition and an increased risk of ischemic heart disease and mortality, again indicating another link between the spleen and the heart.…”

Postsplenectomy sepsis syndrome

“…La penicilina intravenosa ha sido el tratamiento de elección, debido a que provee una excelente actividad contra neumococo y meningococo. Con el cambio en la patente de resistencia, algunos autores proponen el inicio del tratamiento con un antibiótico de amplio espectro, enfatizando el empleo de drogas con actividad contra S. pneumoniae, (13,21,(23)(24)(25)(26) H. influenzae y N. meningitidis. En este sentido, la ceftriaxona constituye la droga de elección .…”