Asplenic patients

Question 1

Asplenic pts are at increased risk for these infections?

Answer 1

at increased risk for Strep pneumoniae, H influenza, Neisseria meningitidis infections

Question 2

what is the potential danger to asplenic pts if they are infected?

Answer 2

they are rare but rapidly fatal if not recognized or treated aggressively in early stage.

they crash fast

Question 3

if patient who is asplenic appears to have mild symptoms with a fever, and not toxic what should you do?

Answer 3

send them to urgent care or ED as they may not appear toxic they can have an infection that can progress to fulminant disease with severe shock, sepsis and DIC

Can treat with empiric abx: amoxicillin-clavulanate, cefuroxime, or extended spectrum fluroroquinolones like levofloxacin

Question 4

how long should asplenic pts who are empirically treated with ABS be on antibiotics

Answer 4

continue 72 hrs while they get diagnostic work up for now

Question 5

timing of elective vaccination for asplenic pts

Answer 5

2 weeks BEFORE elective splenectomy

Question 6

timing of vaccination for asplenic pts if it was done emergently

Answer 6

wait 2 weeks then GIVE

• quadrivalent meningococcus
• PCV13 then 8 weeks later give PSVV23
• H influenzae B if not previously received
• inactivated influenzae vaccine during flu season (can proceed a superinfection)
• all other vaccines recommended for general population.

Question 7

asplenic vaccinations

Answer 7

• quadrivalent meningococcus
• PCV13 then 8 weeks later give PSVV23
• H influenzae B if not previously received
• inactivated influenzae vaccine during flu season (can proceed a superinfection)
• all other vaccines recommended for general population.