Hyposplenism

Question 1

Causes of hyposplenism

Answer 1

Sickle cells disease (chronic sickling and microinfarction in the spleen in infancy)
Coeliac disease, dermatitis herpetiformis | IBD
Graft-versus-host disease
Graves’ disease
SLE
Amyloidosis
Splenectomy

Question 2

What are the indications for splenectomy

Answer 2

Trauma (one of the most commonly injured organs)
- Blunt force
- Rib fractures
- left renal injuries
- Diaphragmatic rupture
- (lacerations are usually self limiting and do not need splenectomy)
Metabolic conditions
Haematological conditions

Question 3

Investigations for hyposplenism

Answer 3

FBC: ?anaemia, sequestration
Blood ilm: Howell-Jolly bodies, siderocytes

CT abdomen: Investigation of choice for splenic trauma

Question 4

Management for hyposplenism

Answer 4

Pneumococcal, meningococcal and H. influenzae vaccination (at least 2 weeks before or after)
Annual influenza vaccination
Long-term penicillin V prophylaxis
At a greater risk of malaria and should be cautious of travel to areas where malaria is endemic
Advice to parents regarding other risks e.g. Dog bites

Question 5

Complications of hyposplenism

Answer 5

Higher risk of infection from encapsulated organisms e.g. N. meningitides, H. influenzae, strep. pneumoniae → meningitis