2. SPLEEN
ā¢ Largest lymphoid organ in body
ā¢ Filtering 10ā15% of the body's blood volume per
minute.
ā¢ Major site of early immunoglobulin M
production, which is important in the acute
clearance of pathogens from the bloodstream.
ā¢ When its function is absent or reduced, the ability
to fight off infection is impaired, particularly from
encapsulated bacterial organisms.
3.
4. Indications for Splenectomy
ā¢ Hemolytic anemia
ā¢ Idiopathic thrombocytopenic purpura.
ā¢ Bleeds following physical trauma or
spontaneous rupture
ā¢ Hypersplenism
ā¢ For diagnosing certain lymphomas
ā¢ The spread of gastric cancer to splenic tissue
9. Cont..
ā¢ Patients may develop concomitant meningitis or
pneumonia, or they may experience convulsions
or cardiovascular collapse.
ā¢ Death can occur within 24 to 48 hours of illness
onset.
ā¢ Mortality is high despite aggressive antibiotic
therapy and intensive medical care
ā¢ Patients who survive often have serious long-term
sequelae, such as deafness; osteomyelitis; or
extensive tissue necrosis, which may potentially
require amputation when extremities are involved.
10. Investigation
ā¢ CBC: Long term effect minimal. Initially
leukocytosis and thrombocytosis
ā¢ Blood, urine, and sputum should be cultured on
hospital admission.
ā¢ PBS: Howell-Jolly bodies present in erythrocytes
of patients without a spleen
ā¢ Lumbar puncture is an important tool in
diagnosing possible meningitis, especially in
small children.
ā¢ Chest radiographs are indicated anytime
pneumonia is suspected
11. Management
ā¢ Initiation of treatment should never be
postponed until the results of these tests are
available because bacterial proliferation occurs
at an accelerated pace.
ā¢ Empiric oral antibiotics may be started by the
patient at home, or antibiotics can be given IM
or IV at the primary care providerās .
ā¢ The antibiotic of choice for treating OPSI has
traditionally been IV penicillin.
12. Cont..
ā¢ Ceftriaxone 100 mg/kg IV or IM, maximum 2
g per dose.
ā¢ IV vancomycin 60 mg/kg/d in divided doses
every 6 hours, maximum 4 g per day.
ā¢ Regimens may be adjusted as the results of
sensitivity testing become available.
13. PREVENTION OF OPSI
ā¢ Vaccine with pneumococcal, Haemophilus
influenzae type B. meningococcal group C and
influenza vaccination at least 2-3 wks before
elective splenectomy.
ā¢ Unimmunized patients should receive the vaccine
shortly after surgery but may be less effective.
ā¢ Pneumococcal re- immunisation should be given
at least 5 years and influenza annually and must
be documented.
14. Contā¦
ā¢ Life- long prophylactic penicilline V 500 mg twice
daily is recommended. In penicillin- allergic consider
macrolide.
ā¢ Patient should be educated regarding the risk of
infection and methods of prophylaxis.
ā¢ Animal bites should be promptly treated to prevent
serious soft tissue infection and septicaemia.
ā¢ Should also be encouraged to wear an identification
bracelet or carry a wallet card notifying others of their
condition in emergency situations.
15. Referances
ā¢ Harrisonās Principles of Internal Medicine, 20th
edition
ā¢ Sandra L. Moffett, PA-C.Overwhelming postsplenectomy
infection: Managing patients at risk. Journal of
American Physician Assistants 2009; 22(7)
ā¢ Morgan Tl, Tomich EB. Overwhelming Post-splenectomy
Infection (OPSI). J Emerg Med. 2012;43(4):758-763.
ā¢ Takehiro Okabayashi, Kazuhiro Hanazaki.
Overwhelming postsplenectomy infection syndrome in
adults - A clinically preventable disease. WorldJournal of
gastroenterology 2008 Jan 14; 14(2): 176ā179.
ā¢ Davidsonās Principles of Medicine, 23rd
edition