Hyposplenism/splenectomy (CH) Flashcards
What is the spleen involved in? (4)
- producing protective humoral antibodies
- production and maturation of B and T cell and plasma cells
- removal of unwanted particulate matter (e.g. bacteria)
- reservoir for blood cells - white cells and platelets in particular
List causes of hyposplenism. (8)
- splenectomy
- sickle cell anaemia
- coeliac disease (dermatitis herpetiformis)
- chronic lymphoid leukaemia
- inflammatory bowel disease
- Grave’s disease
- SLE
- amyloidosis
Which individuals are at increased risk of severe infection?
Those with an absent or dysfunctional spleen - increased risk particularly of encapsulated bacterial infection
What are the most common organisms associated with severe infection in individuals with hyposplenism? (3)
NHS
- Neisseria meningiditis
- Haemophilus influenza type B (Hib)
- Streptococcus pneumoniae (Pneumococcus)
What is a symptom of hyposplenism?
Recurrent infection
What is the spleen like in sickle cell disease?
Enlarged palpable spleen
What might you see after a splenectomy?
Sepsis due to infection:
- pyrexia
- hypotension
- tachycardia
What investigations would you request for hyposplenism?
Abdominal US, CT or MRI
What would a blood film show in hyposplenism? (4)
- Howell-Jolly bodies
- target cells
- pappenheimer bodies (siderocytes) - RBCs containing non-haemoglobin iron
- irregularly contracted RBCs
What are pappenheimer bodies/siderocytes, seen in hyposplenism?
RBCs containing non-haemoglobin iron
What are the indications for a splenectomy? (5)
- trauma (1/4 iatrogenic)
- spontaneous rupture (infectious mononucleosis/EBV)
- hypersplenism (hereditary spherocytosis/elliptocytosis)
- malignancy (lymphoma or leukaemia)
- splenic cysts (hyatid cysts, splenic abscesses)
What is an elective splenectomy?
- very different operation from emergency splenectomy - spleen is often very large
- most cases can be performed laparoscopically
- the spleen will often be macerated inside a specimen bag to facilitate extraction
What changes happen post-splenectomy?
- platelets will rise first - should give platelets in ITP after splenic artery clamped
- blood film will change over following weeks, Howell-Jolly bodies will appear
- other changes - target cells, pappenheimer bodies (siderocytes)
What are some requirements prior to splenectomy? (2)
- vaccination against meningococcus type C, HiB, MMR, pneumococcus (pneumococcal vaccine 2 weeks before elective splenectomy, otherwise every 5 years)
- annual flu vaccination
What is the management plan for individuals who have had a splenectomy?
- immunisations against N. meningitidis, H. influenzae type b, Streptococcus pneumoniae and Influenza virus
- pneumococcal vaccine given 2 weeks before elective splenectomy, otherwise every 5 years
- influenza vaccine yearly
What is recommended in patients at high risk of pneumococcal infections (splenectomy)?
Prophylactic Abx - penicillin or amoxicillin
Patients still susceptible to Haemophilus influenzae as it makes beta lactamase
What prophylactic may you need to start following a splenectomy?
Prophylactic aspirin due to thrombocytosis
What are some requirements after splenectomy? (4)
- splenectomy card
- cautious of risk from dog bites and travel in malaria-endemic areas
- prophylactic Abx - penicillin or erythromycin for a minimum of 2 years
- immunisations - N. meningitidis, H. influenzae type b, S. pneumoniae and influenza
What are some complications of splenectomy? (5)
- haemorrhage
- pancreatic fistula (from iatrogenic damage to ToP)
- thrombocytosis (give prophylactic aspirin)
- encapsulated bacteria infection e.g. S. pneumoniae, H. influenzae, N. meningitidis - risk highest first 2 years following splenectomy
- splenectomy can give falsely high HbA1c due to increased lifespan of RBCs
