HPB

Question 1

Post splenectomy care

Answer 1

o Immunisations (7-14 days before or >7 days after)
▪ Pneumococcus (repeat at 8wks and 5yrs)
▪ Meningococcus ACWY and meningococcus B (repeat at 8wks for both, 5yrs for ACWY)
▪ Haemophilus influenzae B
▪ Influenza (yearly)
- COVID

o Antibiotic prophylaxis
▪ Amoxicillin 250mg daily (allergy – roxithromycin 150mg daily)
▪ 2 years or lifelong (immunocompromise)

o Emergency prophylaxis
▪ 2g amoxicillin stat

o Aspirin
▪ If platelets >1000

• Medi-alert bracelet
• Patient education
• Spleen registry

Question 2

OPSI

Answer 2

overwhelming post-splenectomy infection

o Incidence 3.2%/year
▪ Mortality 40-50%
▪ Greatest risk <2 years post splenectomy and in thalassaemia/sickle cell

o Causative organism
▪ Strep pneumoniae (60%)
▪ Neisseria meningitidis
▪ Haemophilus influenzae

o Presentation
▪ Severe sepsis

o Management
▪ Resuscitation
▪ Cultures
▪ Early IV Abx –vancomycin (penicillin resistant strep pneumoniae and other gram +), ceftriaxone (double coverage of gram +ves and adds gram neg cover for Neisseria meningitidis sand H influenzae)