Hyposplenism/ splenectomy

Question 1

What is hyposplenism?

Answer 1

the reduced or absent function of the spleen, impairing the capacity to prevent bacterial infections. 

Question 2

What is the role of the spleen?

Answer 2

involved in producing protective humoral antibodies, the production and maturation of B and T cells and plasma cells, removal of unwanted particulate matter(eg, bacteria) and also acting as a reservoir for blood cells, especially white cells and platelets

Question 3

What are the risk factors for hyposplenism?

Answer 3

• Operative splenectomy
• SCA
• Coeliac disease
• CLL
• IBD
• Bone marrow transplantation
• Congenital asplenia

Most common organism associated with severe infection is S. pneumoniae (pneumococcus), H. influenzae type b (Hib)and N. meningitidis. (NHS)

Question 4

What are the presenting symptoms/ signs of hyposplenism?

Answer 4

• Bleeding 
• Chills 
• Cough or shortness of breath 
• Difficulty eating or drinking 
• Increased swelling of the abdomen 
• Pain that doesn’t go away with prescribed medications 
• Increasing redness, pain, or discharge (pus) at the incision site 

Question 5

What investigations are used to diagnose/ monitor hyposplenism?

Answer 5

1. Blood Film → Howell-jolly bodies, target cells, pappenheimer bodies (siderocytes)
2. Imaging → ultrasound, CT or MRI
3. Following splenectomy ⇒ thrombocytosis (very high platelet count → may need prophylactic aspirin)

Question 6

How is hyposplenism managed?

Answer 6

1. Immunisations → vaccinations against S. pneumoniae, N. meningitidis, H. influenzae type b and influenza virus are strongly recommended
   - Pneumococcal vaccine 2 weeks before elective splenectomy
   - Annual influenza vaccination and Pneumococcal vaccine every 5 years
2. Prophylactic Antibiotics (Penicillin or Amoxicillin) → recommended in patients at high risk of pneumococcal infections