Hyposplenism/splenectomy Flashcards
What is hyposplenism?
A condition characterized by reduced splenic function.
What are the causes of hyposplenism?
- Splenectomy
- Sickle-cell disease
- Coeliac disease, dermatitis herpetiformis
- Graves’ disease
- Systemic lupus erythematosus
- Amyloid
What are the features of hyposplenism?
- Howell-Jolly bodies
- Siderocytes
What happens to the removal of red blood cells after splenectomy?
The loss of splenic tissue results in the inability to readily remove immature or abnormal red blood cells from the circulation.
How does the red cell count change after splenectomy?
The red cell count does not alter significantly.
What cytoplasmic inclusions may be seen after splenectomy?
Cytoplasmic inclusions such as Howell-Jolly bodies may be seen.
What changes occur in the blood film in the first few days after splenectomy?
Target cells, siderocytes, and reticulocytes will appear in the circulation.
What type of blood cell increase is observed immediately following splenectomy?
A granulocytosis, mainly composed of neutrophils, is seen.
What happens to the white blood cell composition over the weeks following splenectomy?
Granulocytosis is replaced by lymphocytosis and monocytosis.
What happens to the platelet count after splenectomy?
The platelet count is usually increased, and this may be persistent.
What may be needed for some patients due to increased platelet count?
Oral antiplatelet agents may be needed in some patients.
What is hyposplenism?
Hyposplenism can result from splenic atrophy due to certain medical conditions or interventions like splenic artery embolization and splenectomy.
How is hyposplenism diagnosed?
Diagnosis is challenging; peripheral markers like Howell-Jolly bodies are not fully reliable. The most sensitive diagnostic test is a radionucleotide-labelled red cell scan.
What is the risk associated with hyposplenism?
Hyposplenism significantly increases the risk of post-splenectomy sepsis, especially from encapsulated organisms.
Why does hyposplenism increase the risk of infection?
This is due to the spleen’s role in detecting and responding to pathogens.
What are the recommendations for vaccination after splenectomy?
Pneumococcal, Haemophilus type b, and Meningococcal type C vaccines should be administered two weeks before or after splenectomy.
What is the vaccination schedule post-splenectomy?
Men C and Hib at two weeks post-splenectomy; MenACWY vaccine one month later; children under 2 may need a booster at 2 years.
What additional vaccination is recommended for all patients?
Annual influenza vaccination for all patients.
What is the antibiotic prophylaxis recommendation?
Penicillin V should be continued for at least 2 years and at least until the patient is 16 years of age, although the majority of patients are usually put on antibiotic prophylaxis for life.
What precautions should asplenic individuals take when traveling?
Asplenic individuals should use both pharmacological and mechanical protection when travelling to malaria-endemic areas.
What infections are patients at risk for following a splenectomy?
Patients are particularly at risk from pneumococcus, Haemophilus, meningococcus, and Capnocytophaga canimorsus infections.
When should vaccination be done if elective splenectomy is planned?
Vaccination should be done 2 weeks prior to the operation.
What vaccines are recommended before elective splenectomy?
Hib, meningitis A & C, annual influenza vaccination, and pneumococcal vaccine every 5 years.
What is the recommended antibiotic prophylaxis after splenectomy?
Penicillin V should be continued for at least 2 years and at least until the patient is 16 years of age.
What are the indications for splenectomy?
Indications include trauma, spontaneous rupture (EBV), hypersplenism, malignancy (lymphoma or leukaemia), and splenic cysts, hydatid cysts, or abscesses.
How does elective splenectomy differ from emergency splenectomy?
Elective splenectomy is often performed laparoscopically and the spleen is often large and may be macerated inside a specimen bag for extraction.
What are some complications of splenectomy?
Complications include haemorrhage, pancreatic fistula, thrombocytosis, and encapsulated bacteria infections.
What changes occur in blood film after splenectomy?
Platelets will rise, Howell-Jolly bodies will appear, and other changes include target cells and Pappenheimer bodies.
What is post-splenectomy sepsis?
Post-splenectomy sepsis typically occurs with encapsulated organisms, where opsonisation occurs but then is not recognized.
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