Preventing severe infection after splenectomy

Newland, Adrian C.; Provan, Drew; Myint, S.

doi:10.1136/bmj.331.7514.417

Cited by 68 publications

(46 citation statements)

References 9 publications

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“…The role and efficacy of antibiotic prophylaxis in this setting remains unclear, and not all investigators recommend this approach. 1,28 Finally, small, but not insignificant additional risks include thromboembolism and pulmonary hypertension. 29,30 The rate of splenectomy in adults is not known 2 while in a large pediatric series of 256 AIHA (99 of whom with Evans syndrome) splenectomy was performed in 13.9% of cases.…”

Section: Splenectomymentioning

confidence: 99%

Treatment of autoimmune hemolytic anemias

2014

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Autoimmune hemolytic anemia (AIHA) is a relatively uncommon disorder caused by autoantibodies directed against self red blood cells. It can be idiopathic or secondary, and classified as warm, cold (cold hemagglutinin disease (CAD) and paroxysmal cold hemoglobinuria) or mixed, according to the thermal range of the autoantibody. AIHA may develop gradually, or have a fulminant onset with life-threatening anemia. The treatment of AIHA is still not evidence-based. The first-line therapy for warm AIHA are corticosteroids, which are effective in 70-85% of patients and should be slowly tapered over a time period of 6-12 months. For refractory/relapsed cases, the current sequence of second-line therapy is splenectomy (effective approx. in 2 out of 3 cases but with a presumed cure rate of up to 20%), rituximab (effective in approx. 80-90% of cases), and thereafter any of the immunosuppressive drugs (azathioprine, cyclophosphamide, cyclosporin, mycophenolate mofetil). Additional therapies are intravenous immunoglobulins, danazol, plasma-exchange, and alemtuzumab and high-dose cyclophosphamide as last resort option. As the experience with rituximab evolves, it is likely that this drug will be located at an earlier point in therapy of warm AIHA, before more toxic immunosuppressants, and in place of splenectomy in some cases. In CAD, rituximab is now recommended as first-line treatment. ABSTRACT Treatment of warm AIHAThe traditional treatment of AIHA includes corticosteroids, splenectomy and conventional immunosuppressive drugs. Over recent years, some new therapies have become available and there has been some evidence of success. These therapies are primarily used in patients who are not candidates for or fail to respond to splenectomy, those who relapse after splenectomy, and those who cannot maintain stable hemoglobin levels without unacceptably high doses of corticosteroids. First-line therapy CorticosteroidsThere is general agreement that corticosteroids represent the first-line treatment for patients with warm antibody type AIHA, albeit their use is based on experience rather than hard evidence. In fact, there is little published information on their effectiveness, 1,16,17 and this is not supported by clinical trials. Corticosteroids, usually prednisone, are given at the initial dose of 1.0-1.5 mg/kg/day for 1-3 weeks until hemoglobin levels greater than 10 g/dL are reached. Response occurs mainly during the second week, and if none or minimal improvement is observed in the third week, this therapy is assumed to be ineffective. After stabilization of hemoglobin, prednisone should be gradually and slowly tapered off at 10-15 mg weekly to a daily dose of 20-30 mg, then by 5 mg every 1-2 weeks until a dose of 15 mg, and subsequently by 2.5 mg every two weeks with the aim of withdrawing the drug. Although one might be tempted to discontinue steroids more rapidly, AIHA patients should be treated for a minimum of three or four months with low doses of prednisone (≤10 mg/day).1 In fact, patients receiving low doses of cortico...

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Section: Splenectomymentioning

confidence: 99%

Treatment of autoimmune hemolytic anemias

2014

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“…43 Contraindications to the use of semi-permanent needles in cancer patients have been described, 54 and include valvular heart disease or valve replacement because of the risk of subacute bacterial endocarditis; an indwelling pacemaker; current chemotherapy and radiotherapy likely to produce intermittent severe immunosuppression with neutropenia. Patients who have had a splenectomy are relatively immunocompromised and more susceptible to infections, 55 so should be included in the group in whom indwelling studs are contraindicated. In addition, standard contraindications to the use of studs in all patients include: 'strong reactors' to acupuncture, in case they become too sleepy with treatment; patients with known hepatitis B or C, to avoid the risk of blood borne infection to others if the stud falls out and is mislaid; and local factors that increase risk eg oedema.…”

Section: Acupuncture Approach For Hot Flushesmentioning

confidence: 99%

Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm

Filshie

Bolton²,

Browne

et al. 2005

Acupunct Med

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Introduction Since hormone replacement therapy given for long periods is now recognised to produce serious side effects, patients with troublesome vasomotor symptoms are increasingly using non-hormonal treatment including acupuncture. Several randomised controlled trials have shown that acupuncture reduces menopausal symptoms in patients experiencing the normal climacteric. It may have this effect by raising serotonin levels which alter the temperature set point in the hypothalamus. Va somotor symptoms can be extreme in breast cancer patients and patients with prostate cancer who are undergoing anticancer therapy. The safety of some herbal medicines and phytoestrogens has been questioned, as they could potentially interfere adversely with the bioavailability of tumouricidal drugs. Aprevious study reports short term benefit from acupuncture, and the aim of this report is to describe our approach to long term treatment. Acupuncture approach After piloting several approaches, six weekly treatments were given initially at LI4, TE5, LR3 and SP6 and two upper sternal points, but avoiding any limb with existing lymphoedema or prone to developing it. If there were no contraindications, patients were given clear instructions on how to perform self acupuncture using either semi-permanent needles or conventional needling at SP6, weekly for up to six years, for long term maintenance. Audit methods and results Aretrospective audit of electronic records was carried out by a doctor not involved in treatment. Atotal of 194 patients were treated, predominantly with breast and prostate cancer. One hundred and eighty two patients were female. The number of pre-treatment hot flushes per day was estimated by the patient: in the 159 cases providing adequate records, the mean was 16 flushes per day. Following treatment, 114 (79%) gained a 50% or greater reduction in hot flushes and 30 (21%) a less than 50% reduction. Treatment was abandoned in those who responded poorly or not at all. The duration of treatment varied from one month to over six years with a mean duration of nine months. Seventeen patients (9%) experienced minor side effects over the six year period, mostly minor rashes; one patient described leg swelling but this was likely to be due to a concurrent fracture. Conclusion Acupuncture including self acupuncture is associated with long term relief of vasomotor symptoms in cancer patients. Treatment is safe and costs appear to be low. An algorithm is presented to guide clinical use. We recommend the use of self acupuncture with needles at SP6 in preference to semipermanent needles in the first instance, but poor responders use indwelling studs if they fail to respond adequately to self acupuncture with regular needles. Point location may be of less importance than the overall 'dose', and an appropriate minimum dose may be required to initiate the effect.

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“…Splenectomy indications are the most important risk factor for the development of post-splenic mortality (12,31,32). Trauma patients with isolated splenic injuries are the best indication group for the prognosis (33,34).…”

Section: Discussionmentioning

confidence: 99%

Splenectomy indications and postoperative follow-up results of a department of general surgery

Emre¹,

Şanlı²

2018

J Turgut Ozal Med Cent

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Aim: Splenectomy is commonly performed in many centers around the world for the treatment of various benign, malign diseases and trauma nowadays. The purpose of this study is to determine the indications in patients undergoing splenectomy in a general surgery department for five years and to investigate the mortality rate and reasons. Material and Methods: Data of the study were obtained retrospectively by scanning records of patients over the age of 18 who underwent open splenectomy in the general surgery department between December2012 and December2017. Demographic data, duration of hospitalization, distribution of emergency and elective operations, main reasons and indications of splenectomy, operation components, histopathological results, the survey of patients and mortality rate were investigated. Results: 55,4% (n=31) female, 44,6% male, total 56 patients were included in the study. The mean age of the patients was 50.5±22,6. The mean duration of hospitalization was 9±7 days. 71.4%of the patients were operated under elective conditions and 28.6%of the patients were operated under urgent conditions. Splenectomy was done for the reason of carcinoma in 34.2% of patients, traumatic splenic injury in 19.4%, splenic cyst or abscess in 16.2%, coagulopathy in 12.6%, iatrogenic splenic injury in 5.4%, lymphoma in 3.6%, splenomegaly associated with portal hypertension in 3.6%, fibrosarcoma in 1.8%, idiopathic splenomegaly in 1.8%. Conclusion: Splenectomy is performed in general surgery departments due to traumatic and non-traumatic indications. Mortality due to pure splenic pathologies is uncommon and quite rare. However, mortality caused by other operations and diseases in patients who underwent splenectomy is quite high.

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Preventing severe infection after splenectomy

Cited by 68 publications

References 9 publications

Treatment of autoimmune hemolytic anemias

Treatment of autoimmune hemolytic anemias

Acupuncture and Self Acupuncture for Long Term Treatment of Vasomotor Symptoms in Cancer Patients - Audit and Treatment Algorithm

Splenectomy indications and postoperative follow-up results of a department of general surgery

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