To use all functions of this page, please activate cookies in your browser.
With an accout for my.bionity.com you can always see everything at a glance – and you can configure your own website and individual newsletter.
- My watch list
- My saved searches
- My saved topics
- My newsletter
Asplenia refers to the absence ('a-') of normal spleen function and is associated with some serious infection risks. Hyposplenism is used to describe reduced ('hypo-') splenic functioning, but not as severely affected as with asplenism.
Additional recommended knowledge
Partial splenectomy preservation of splenic function
In an effort to preserve some of the spleen's protective roles, attempts are now often made to preserve a small part of the spleen when performing either surgical subtotal (partial) splenectomy, or partial splenic embolization. This may be particularly important in poorer countries where protective measures for patients with asplenia are not available. However it has been advised that preoperative vaccination is advisable until the remnant splenic tissue can reestablish its function.
Asplenia increases the risk of septicaemia from encapsulated bacteria, and can result in a syndrome known as overwhelming post splenectomy infection (OPSI) which can kill within a few hours. In particular, patients are at risk from Pneumococcus, Haemophilus influenzae, and meningococcus. The risk is elevated as much as 350-fold.
The risk to asplenic patients has been expressed as equivalent for a child to die in home accident, and for adults dying in a road traffic accident (reference UK Splenectomy Trust Advice) - so sensible precautions are needed, but no panic.
To minimise the risks, antibiotic & vaccination protocols have been established, but are often poorly adhered to by doctors and patients.
Because of the increased risk of infection, physicians administer oral antibiotics as a prophylaxis after a surgical splenectomy (or starting at birth, for congenital asplenia or functional asplenia). The duration suggested varies: one suggestion is that antibiotics be taken for two years or until the age of sixteen years old is reached, whichever is longer.
Patients are also cautioned to start a full-dose course of antibiotics at the first onset of an upper or lower respiratory tract infection (for example, sore throat or cough), or at the onset of any fever.
It is suggested that splenectomized persons receive the following vaccinations, and ideally prior to planned splenectomy surgery:
In addition to the normal immunisations advised for the countries to be visited, Group A meningococcus should be included if visiting counties of particular risk (e.g. sub-saharan Africa). The non-conjugated Meningitis A&C vaccines usually used for this purpose give only 3 years coverage and provide less-effective long-term cover for Meningitis C than the conjugated form already mentioned.
Those lacking a functional spleen are at higher risk of catching malaria and dying from this. Travel to malarial areas will carry greater risks and may be best avoided. Travellers should take the most appropriate anti-malarial prophylaxis medication and be extra vigilant over measures to prevent mosquito bites.
The pneumococcal vaccinations may not cover some of the other strains of pneumococcal bacteria present in other countries. Likewise their antibiotic resistance may also vary, requiring a different choice of stand-by antibiotic.
Categories: Immune system disorders | Hematology
|This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Asplenia". A list of authors is available in Wikipedia.|