Understanding of the significance and health implications of asplenia in a cohort of patients with haemaglobinopathy: possible benefits of a spleen registry

Premawardena, Chamath; Bowden, Donald Keith; Kaplan, Zane; Dendle, Claire; Woolley, Ian

doi:10.1080/10245332.2017.1414910

Cited by 7 publications

(11 citation statements)

References 14 publications

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“…In another retrospective cohort study, Arnott A. et al concluded that systemic, long-term approaches can significantly minimize the risk of infection with encapsulated pathogens among splenectomized individuals [48]. According to Premawardena C et al, major benefits of the registry were not related to the knowledge but in the delivery of the recommended vaccines and the use of a medical alert card [49].…”

Section: Benefits Of Having a Spleen Registrymentioning

confidence: 99%

Post-splenectomy Sepsis: A Review of the Literature

Tahir¹,

Ahmed²,

Malik³

2020

Cureus

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The spleen is an intraperitoneal organ that performs vital hematological and immunological functions. It maintains both innate and adaptive immunity and protects the body from microbial infections. The removal of the spleen as a treatment method was initiated from the early 1500s for traumatic injuries, even before the physiology of spleen was properly understood. Splenectomy has therapeutic effects in many conditions such as sickle cell anemia, thalassemia, idiopathic thrombocytopenic purpura (ITP), Hodgkin's disease, and lymphoma. However, it increases the risk of infections and, in some cases, can lead to a case of severe sepsis known as overwhelming post-splenectomy infection (OPSI), which has a very high mortality rate. Encapsulated bacteria form a major proportion of the invading organisms, of which the most common is Streptococcus pneumoniae. OPSI is a medical emergency that requires prompt diagnosis (with blood cultures and sensitivity, blood glucose levels, renal function tests, and electrolyte levels) and management with fluid resuscitation along with immediate administration of empirical antimicrobials. OPSI can be prevented by educating patients, vaccination, and antibiotic prophylaxis. This article summarizes the anatomy and physiology of the spleen and highlights its important functions. It primarily focuses on the pathophysiology of OPSI, its current management, and prevention strategies.

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Section: Benefits Of Having a Spleen Registrymentioning

confidence: 99%

Post-splenectomy Sepsis: A Review of the Literature

Tahir¹,

Ahmed²,

Malik³

2020

Cureus

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“… 6–8 Despite this, PWA/H are often managed inappropriately which leaves them exposed to unnecessary risk and speaks to a gap in knowledge translation. 9 Some work in this patient population has been previously done, 10 11 however, to our knowledge, the evaluation of a multimodal quality improvement intervention for both PWA/H and their healthcare providers has not previously been performed. We present the methodology employed in the development of this programme and the pilot data from a tertiary care centre that explored whether a medical alert card and patient/healthcare provider educational booklet increase vaccination rates and improve awareness and understanding of the infectious implications of a/hyposplenia in adults.…”

Section: Problemmentioning

confidence: 99%

“…A questionnaire method has been used in similar patient populations to ascertain patient knowledge of infection and its prevention. 10 17 The questionnaires were a cost-effective method that would assess our outcome measures with minimal disruption of clinical flow. The questionnaires also provided anonymity, particularly important for questions regarding satisfaction.…”

Section: Measurementmentioning

confidence: 99%

“…We chose a medical alert card and education intervention based on recommendations made in previous studies, 8 16 and the benefits shown in an existing programme. 10 18 In the haematology clinic, a preintervention questionnaire was administered to patients prior to the distribution of the toolkit. The postintervention questionnaire was administered at the patient’s next visit to the clinic.…”

Section: Designmentioning

confidence: 99%

“… 3 There is evidence to support the utility of an alert card and education programme that addresses this infection risk in this patient population. 10 11 18 The risk of infection can be significantly reduced by using systematic, long-term approaches to care of PWA/H. 18 …”

Section: Introductionmentioning

confidence: 99%

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The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia

et al. 2020

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Asplenia and hyposplenia (a/hyposplenia) are associated with increased morbidity and mortality from complications including infection. The recommended measures to reduce the risks associated with infection include patient education, vaccination and early initiation of antibiotic therapy for fever. Despite these recommendations, there is poor adherence to best practice management of patients with asplenia or hyposplenia (PWA/H). We present the development methodology and pilot data of a quality improvement project that explored whether a programme involving a novel medical alert card together with a patient and healthcare provider educational booklet increased vaccination rates and improved awareness and understanding of the infectious implications of a/hyposplenia. Our aim was to increase the proportion of those appropriately vaccinated and the proportion of patients with proper understanding of fever management by twofold in 18 months. Questionnaires were used locally as a root-cause-analysis to confirm the need for education and evaluate the effectiveness of the programme, as well as patient satisfaction. An interdisciplinary team developed a toolkit composed of a medical alert card and booklet. The toolkit was distributed to PWA/H who presented for a haematology clinic visit at a tertiary care centre. A separate set of questionnaires was then used to evaluate satisfaction and obtain feedback from patients and practitioners receiving the toolkit for the first time. Changes suggested by patients and practitioners with unanimous agreement among study investigators were made to the toolkit. The pilot study showed an increase in vaccination rates and awareness of vaccination status and appropriate fever management. The majority of the patients and practitioners found the information provided by the toolkit helpful. Given these promising single-centre findings, the intervention is being extended to another tertiary care centre with a large red blood cell disorders programme to evaluate its generalisability. The next step will be to expand the scope to paediatric PWA/H.

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