Hyposplenism/splenectomy - covered in GI Flashcards
What are the causes of hyposplenism?
Causes include splenectomy, sickle-cell disease, coeliac disease, dermatitis herpetiformis, Graves’ disease, systemic lupus erythematosus, and amyloid.
What are the features of hyposplenism?
Features include Howell-Jolly bodies and siderocytes.
What happens to the ability to remove 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.
Does the red cell count change significantly 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 leukocytosis is observed immediately following splenectomy?
A granulocytosis, mainly composed of neutrophils, is seen.
What changes in leukocyte composition occur in 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 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 risk does hyposplenism pose?
Hyposplenism significantly increases the risk of post-splenectomy sepsis, especially from encapsulated organisms.
Why does hyposplenism increase the risk of sepsis?
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 after 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 is the recommendation for pneumococcal vaccines?
Annual influenza vaccination for all patients.
What is the guideline for antibiotic prophylaxis?
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 after a splenectomy?
Patients are particularly at risk from pneumococcus, Haemophilus, meningococcus, and Capnocytophaga canimorsus infections.
When should vaccinations be administered if a splenectomy is elective?
Vaccination should be done 2 weeks prior to the operation.
What vaccines are recommended before a splenectomy?
Hib, meningitis A & C, annual influenza vaccination, and pneumococcal vaccine every 5 years.
What is the recommended antibiotic prophylaxis after a 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 a splenectomy?
Indications include trauma, spontaneous rupture (e.g., EBV), hypersplenism, malignancy (e.g., lymphoma or leukaemia), splenic cysts, hydatid cysts, and splenic abscesses.
