Prevention and management of overwhelming postsplenectomy infection-An update

Brigden, Malcolm L.; Pattullo, A

doi:10.1097/00003246-199904000-00050

Cited by 178 publications

(119 citation statements)

References 33 publications

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“…OPSI is a medical emergency for which only prompt diagnosis and immediate treatment can reduce mortality (56). The mortality rate is 50-70%, and most deaths occur within the first 24 h (60).…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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Section: Resultsmentioning

confidence: 99%

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Moris

Dimitriou

Grınıatsos

2017

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“…In children less than 5 years old, the risk of overwhelming postsplenectomy sepsis may be increased 60-to 100 fold, compared with that of children without a splenectomy (18) There are also concerns that despite the immunizations against encapsulated bacteria and the postoperative antibiotic prophylaxis, the risk after total splenectomy is never eliminated. (17,19,20) Because of this reason, a number of alternatives to total splenectomy have been considered, including auto-transplantation of the removed spleen and partial splenectomy. (21) The use of partial splenectomy, particularly in pediatric patients, aims to retain splenic immunologic function, while at the same time to decrease the rate of hemolysis.…”

Section: The Role Of Splenectomy In Hereditary Spherocytosismentioning

confidence: 99%

Hereditary Spherocytosis - Diagnosis, Surgical Treatment and Outcomes. A Literature Review

Manciu¹,

Matei²,

Trandafir³

2017

chr

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RezumatSferocitoza ereditarã este o maladie congenitalã, caracterizatã prin anemie hemoliticã, ce afecteazã membranele eritrocitelor. Manifestãrile clinice variazã de la forme aproape asimptomatice la forme severe, ce necesitã transfuzii. Diagnosticul se bazeazã pe examenul clinic, hemograma cu numãrul reticulocitelor, prezenţa unui istoric familial şi teste de laborator specific, cum ar fi testul EMA (eosin-5-maleimide binding test) sau testul AGLT (Acidified Glycerol Lysis Time). Splenectomia este consideratã tratamentul standard în formele moderate pânã la severe de boalã. Totuşi, este cunoscut faptul cã splenectomia totalã expune pacientul la complicaţii infecţioase, uneori letale, ceea ce a determinat indicarea acestei metode cu precauţie. Astfel splenectomia subtotalã sau parţialã a devenit o alternativã de tratament fezabilã. Aceasta reduce distrugerea eritrocitelor, în timp ce conservã funcţia imunã a splinei. Majoritatea studiilor au arãtat beneficii certe, pe termen scurt, dupã splenectomie, în cazul acestor pacienţi. Totuşi, pânã în prezent, rezultate pe termen lung certe, adicã pe o perioadã de peste 5 ani de urmãrire postoperatorie, încã lipsesc.Cuvinte cheie: sferocite, hemoliză, citometrie în flux, splenectomie, rezultate pe termen lung AbstractHereditary spherocytosis (HS) is a disease affecting the red blood cells membrane and belongs to the congenital hemolytic anemias. The clinical spectrum ranges from asymptomatic patients to severe forms requiring transfusions in early childhood. The diagnosis can be based on the physical examination, complete red blood cell count, reticulocytes count, medical history and specific tests, preferentially the EMA test (eosin-5-maleimide binding) test and AGLT (Acidified Glycerol Lysis Time). Splenectomy is considered the standard surgical treatment in moderate and severe forms of hereditary spherocytosis. Total splenectomy exposes the patient to a life -long risk of potentially lethal infections and thus, its usage was reconsidered. Because of this reason, a feasible alternative is the partial splenectomy. The use of partial splenectomy aims to retain splenic immunologic function, while at the same time to decrease the rate of hemolysis. The long -term outcomes of patients with total or subtotal splenectomy for congenital hemolytic anemia, still remain unclear, but the majority of the studies showed a qualitative resolution of anemia and reduction of transfusion rate. Despite the well known advantages of conservative surgery, the optimal choice of treatment and outcomes should be confirmed with the patient.

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“…Although meningitis or pneumonia will accompany OPSI in 50% of cases, in many patients there is no obvious site of bacterial colonization and a cryptic source originating in the nasopharynx is postulated. The prodromal stage may be mild and nonspecific with flu-like symptoms [4]. These symptoms may include fever, malaise, myalgias, headache, vomiting, diarrhea, and abdominal pain.…”

Section: Discussionmentioning

confidence: 99%

Cases of Opsi syndrome still candidate for medical ICU

et al. 2008

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Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (OPSI) syndrome. It seems to be more common in children, but occurs at all ages. The risk is greatest in the early months and years after operation, but never disappears entirely. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. In this paper, three cases of OPSI syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. With the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients.

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Prevention and management of overwhelming postsplenectomy infection-An update

Cited by 178 publications

References 33 publications

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review

Hereditary Spherocytosis - Diagnosis, Surgical Treatment and Outcomes. A Literature Review

Cases of Opsi syndrome still candidate for medical ICU

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