The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination

Dionne, Brandon; Dehority, Walter; Brett, Meghan; Howdieshell, Thomas R.

doi:10.1089/sur.2016.267

Cited by 21 publications

(9 citation statements)

References 64 publications

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“…OPSS can occur anytime after removal of the spleen and the estimated lifetime risk is approximately 5%. However, the mortality rate associated with OPSS is approximately 50%-70% (Bisharat, Omari, Lavi, & Raz, 2001;Morgan & Tomich, 2012) The initial prodrome is insidious with mild, nonspecific symptoms such as fever, chills, fatigue, and myalgias that may be followed by rapid clinical deterioration often occurring within hours (Dionne, Dehority, Brett, & Howdieshell, 2017;Rubin & Schaffner, 2014). OPSS is most commonly caused by encapsulated organisms such as Streptococcus pneumonia, Neisseria meningitidis, and Haemophilus influenza type b.…”

Section: Background and Purposementioning

confidence: 99%

Postsplenectomy vaccination guideline adherence

Carrico

Goss

Wojcik

et al. 2017

Journal of the American Association of Nurse Practitioners

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Background and purpose Patients undergoing splenectomy for trauma are at life‐long risk for rapidly progressive septicemia. The purpose of this study was to investigate long‐term patient understanding and follow‐up with recommendations regarding their asplenia. Methods Patients undergoing splenectomy for trauma January 2010–December 2014 were analyzed. Medical records were reviewed and telephone follow‐up interviews were conducted in October–December 2015. Patients were asked a standard set of questions that included hospitalizations, awareness of infectious risks associated with asplenia, need for revaccination, and vaccines they had received since their index hospitalization. Findings Two hundred forty‐four patients underwent splenectomy during the study period. A total of 95 patients (39%) were included in the study. Thirty (32%) had been hospitalized since their trauma admission. Only 46% were aware of the risks for sepsis and the need to revaccinate. Only 7% reported having rapid access to antibiotics. Conclusions Despite uniform education prior to discharge, most patients undergoing splenectomy for trauma were unaware of the risks for sepsis and did not follow recommended guidelines for risk reduction. Implications for practice Improvements that have direct implications for advanced practice included the need to refer for vaccination, educate regarding infection risks, and facilitate rapid access to antibiotic treatment.

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Section: Background and Purposementioning

confidence: 99%

Postsplenectomy vaccination guideline adherence

Carrico

Goss

Wojcik

et al. 2017

Journal of the American Association of Nurse Practitioners

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“…Until the 1960s most authorities recommended splenectomy for all children with traumatic splenic rupture and cited mortality rates of up to 100 per cent if surgery was not performed promptly 8 . Then, knowledge of overwhelming postsplenectomy infection increased and non‐operative management gradually became the standard of care.…”

Section: Discussionmentioning

confidence: 99%

Disparities in the management of paediatric splenic injury

Warwick

Jenks

Fisher

et al. 2019

Journal of British Surgery

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Background The non‐operative management of splenic injury in children is recommended widely, and is possible in over 95 per cent of episodes. Practice appears to vary between centres. Methods The Trauma Audit and Research Network (TARN) database was interrogated to determine the management of isolated paediatric splenic injuries in hospitals in England and Wales. Rates of non‐operative management, duration of hospital stay, readmission and mortality were recorded. Management in paediatric surgical hospitals was compared with that in adult hospitals. Results Between January 2000 and December 2015 there were 574 episodes. Children treated in a paediatric surgical hospital had a 95·7 per cent rate of non‐operative management, compared with 75·5 per cent in an adult hospital (P < 0·001). Splenectomy was done in 2·3 per cent of children in hospitals with a paediatric surgeon and in 17·2 per cent of those treated in an adult hospital (P < 0·001). There was a significant difference in the rate of non‐operative management in children of all ages. There was some improvement in non‐operative management in adult hospitals in the later part of the study, but significant ongoing differences remained. Conclusion The management of children with isolated splenic injury is different depending on where they are treated. The rate of non‐operative management is lower in hospitals without a paediatric surgeon present.

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“…The age of the child (maximum under 2 years and however high up to 5 years), the time elapsed from the splenectomy (greater risk in the first 2-3 years that then decreases without ever zeroing and resurfacing after 60 years), the basic disease (drepanocytosis, thalassemia and some neoplastic pathologies and in traumas) are known as risk factors for OPSI [12][13][14].…”

Section: Splenectomymentioning

confidence: 99%

Role of Partial Splenectomy in Hematologic Childhood Disorders

et al. 2021

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The spleen is a secondary lymphoid organ that belongs to the reticular-endothelial system, directly connected to blood circulation. The spleen is greatly involved in the immune response, especially against capsulated bacteria. Splenectomy plays a fundamental role in the treatment of numerous pediatric hematologic disorders. Taking into account all the possible complications (especially infections) linked to this procedure, alternatives to total splenectomy have been sought. Partial splenectomy has been proposed as a treatment that allows the reduction of infectious risk. This approach has proven safe and feasible in most patients, but multicentric and prospective studies are necessary to more accurately define the indications for performing partial splenectomy. However, vaccinations and antibiotic prophylaxis remain fundamental for preventing serious infections, even in the case of partial splenectomy. We review anatomical and functional properties of the spleen, with a focus on medical or surgical indications to splenectomy, aiming to give practical educational information to patients and their families after splenectomy. Furthermore, we discuss the feasibility of partial splenectomy in children with hematologic diseases who require splenectomy.

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The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination

Abstract: Immunization remains a key measure to prevent overwhelming post-splenectomy infection. Consideration of new recommendations and indications, possible interactions, and timing remains important to including optimal response to the vaccines.

Cited by 21 publications

References 64 publications

Postsplenectomy vaccination guideline adherence

Postsplenectomy vaccination guideline adherence

Disparities in the management of paediatric splenic injury

Role of Partial Splenectomy in Hematologic Childhood Disorders

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