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Home | Articles | Infectious Diseases | Post Splenectomy Sepsis

Post Splenectomy Sepsis

Last updated 3rd December 2020

Last updated on 20th November 2013 by Calum Murray

Background

  1. Patients with absent or dysfunctional spleen are at risk of overwhelming infection, particularly those due to encapsulated organisms.
  2. Commonest pathogen is Strep Pneumoniae, but H.Influenzae type B, N meningitidis and Malaria also pose significant risks.

Causes of Hyposplenism

  1. Commonest cause is surgical splenectomy
  2. Also occurs as a complication of certain medical conditions esp sickle cell disease and, to a lesser extent, coeliac disease.

Recognition

  1. The clue to diagnosis when hyposplenism not previously suspected is presence of Howell-Jolly bodies in peripheral blood.
  2. Howell-Jolly bodies are small round basophilic (blue) nuclear remnants seen in red cells that are normally cleared from circulation by spleen

Anti-infection Prophylaxis

  1. Education of the patient
  2. Appropriate vaccination
  3. Prophylactic antibiotics providing pneumococcal cover

Education of Patient

  1. Encourage patients to wear an alert bracelet and carry a card with information about their condition
  2. Educate patients about risks of overseas travel and of malaria in particular
  3. Make patient aware that breakthrough pneumococcal infection can occur despite vaccination and antibiotic prophylaxis

Vaccination

  1. All patients should receive Pneumococcal, H Influenzae type b and Meningococcal vaccines
  2. Ideally give 2 weeks before and 2 weeks after splenectomy
  3. Give as soon as is practicable after diagnosing non-surgical hyposplenism, though might be appropriate to delay if recovering from immunosuppression eg chemo for haem malignancy
  4. For full details of immunisation schedules click link to British Journal of Haematology (below)

Prophylactic Antibiotics

  1. Offer life long prophylactic antibiotics to patients at high risk of pneumococcal infection. Use penicillin V 250mg bd or 500mg od if compliance likely to be a problem, or erythromycin 250-500mg od if allergic to penicillin. 
  2. High risk suggested by age <16 or >50 years, poor serological response to vaccine, previous invasive pneumococcal disease, splenectomy for haematological malignancy
  3. Patients not at high risk should be counselled regarding the risks and benefits of lifelong antibiotics and may choose to discontinue them eg amoxil 500mg tds orally.
  4. All patients should carry a supply of appropriate antibiotic for emergency use

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