Most serious infections related to the post splenectomy state occur in the. Late postoperative followup of patients undergoing subtotal. A splenectomy is sometimes performed if the patients spleen has become painfully enlarged. Pdf overwhelming postsplenectomy infection opsi syndrome is a rare condition, but is associated with high mortality. Opsi developed after a median of almost 6 years after splenectomy, and 70% of the infections occurred 2 years after splenectomy. Previously, we verified that postsplenectomy infection is very rare in adults. Opss can be life threatening, and it is absolutely essential to seek immediate treatment. A spleen is removed in a surgical procedure called a splenectomy.
Post splenectomy vaccine prophylaxis summary the splenectomized patient should be vaccinated to decrease the risk of overwhelming postsplenectomy sepsis opss due to organisms such as streptococcus pneumoniae, haemophilus influenzae type b, and neisseria meningitidis. Postsplenectomy syndrome uf health, university of florida. Feb 03, 2020 laparoscopic splenectomy is surgery to take out all or a part of your spleen. The post splenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Splenectomy is an important component of treatment for patients with severe hereditary. It may develop immediately or as late as 65 years postsplenectomy 24. The spleen is one of the most frequently injured intraperitoneal organs, and management of splenic injuries may require splenectomy or, rarely, splenorrhaphy. Oct 29, 2018 background open splenectomy is performed in two major clinical scenarios. Postsplenectomy vaccine prophylaxis surgical critical care.
It removes old and damaged blood cells as blood passes through it. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. Jan 14, 2008 overwhelming postsplenectomy infection opsi is a serious fulminant process that carries a high mortality rate24. The spleen is an important part of the bodys defense immune. A splenectomy is surgery to remove the entire spleen, a delicate, fistsized organ that sits under the left rib cage near the stomach. Thalassemia is a hereditary form of anemia that is most common in people of mediterranean origin. The following interventions will reduce, but not abolish the risk of sepsis. Splenectomy is a surgical procedure to remove your spleen.
Post traumatic seizure prophylaxis in patients with traumatic brain injury management of patients with traumatic brain injuries on anticoagulant or antiplatelet therapy management of. Previous studies have reported mean intervals between splenectomy and first severe sepsis of only 1 or 2 years 4, 5, 10. If you do not have a spleen or your spleen does not work well, talk with your doctor about. However, recognition and clinical management of opsi is not well established. Postsplenectomy syndrome can occur after surgery to remove the spleen. Immunological and clinical consequences of splenectomy in a. It is created by ehealthme based on reports from food and drug administration fda, and is updated regularly. When combining utilization of heparin, enoxaparin, and dalteparin for vte. Splenectomy procedure, recovery, blood, removal, pain.
Treatment of feltys syndrome with the haemopoietic growth factor granulocyte colonystimulating factor gcsf. The impairment of splenic function is defined as hyposplenism, an acquired disorder caused by several haematological and immunological diseases. Thrombocytosis increased platelet count, which can cause blood clots. Because the spleen is the largest lymphoid organ in the body with concentrated amounts of t and b cells, macrophages, and dendritic cells, splenectomy in patients with cirrhosis has produced concern over decreased tumor immunity and an elevated risk of infection, such as overwhelming pneumococcal sepsis 3 4 5. Overwhelming postsplenectomy infection syndrome in adults a. Risk of infection and death among postsplenectomy patients. Postsplenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections.
Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Overwhelming postsplenectomy infection syndrome is a devastating complication that may affect almost a third of splenectomy cases within the first 10 years post surgery. Splenectomy may increase the risk for the development of natalizumabassociated pml via effects on the b cell compartment. Overwhelming postsplenectomy infection syndrome in adults. Postsplenectomy syndrome information mount sinai new york. Occurs post splenectomy in 4% of patients without prophylaxis. It is an acquired condition and is defined as autoimplantation of one or more focal deposits of splenic tissue in various compartments of the body. Splenectomy definition of splenectomy by medical dictionary. The operation is relatively safe for young and middleaged adults. Pneumococcal vaccine status vaccines before splenectomy booster after splenectomy if the pcv administered was pcv7 then a dose of pcv is warranted before the ppsv23 some sources state that children 6 years of age can receive one dose of pcv and not the two priming doses, but we prefer 2for. Management of overwhelming postsplenectomy infection syndrome. Pdf overwhelming postsplenectomy infection syndrome in. Overwhelming postsplenectomy infection opsi syndrome is a rare condition, but is associated with high mortality.
Mortality is significant and reported to be as high as 50% 4,5. Splenectomy was found to be one of the main causes of thrombocytosis. In these cases, multimodality therapy combining surgery with systemic. The prevalence of splenectomy increased recently because it was a clinically effective treatment for hepatitis c virusassociated. Successful treatment of evans syndrome post liver transplant with splenectomy and switch from tacrolimus to cyclosporine. As always, we rely on you to call if you have any questions or concerns regarding your pets recovery and postoperative care. Thromboembolism following splenectomy is another complication for this patient group, which has about 10% mortality following the surgery. An overwhelming post splenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. Basics topics splenectomy is generally indicated in the patient with felty syndrome fs with nonhealing leg ulcers or with recurrent or severe infections pneumonia orrecurrent or severe infections eg, pneumonia or septicemia despite medical therapies. Feb 24, 2015 overwhelming post splenectomy infection. Tdap vaccine to protect against whooping cough and tetanus. The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections.
Comprising intravenous fluids, antibiotics, vasopressors, steroids, heparin, packed red blood cells, platelets, cryoprecipitates, and fresh frozen plasma, it may fail to alter the course of this fulminant septic syndrome. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood. The term asplenia refers to the absence of the spleen, a condition that is rarely congenital and. The objective of this study was to investigate the cause, prompt diagnosis, and outcome of the fatal. Pdf successful treatment of evans syndrome post liver. Feb 12, 2015 if pre splenectomy vaccines are not possible then the vaccines should be given 2 weeks postop except when there is immunosuppression then vaccines should be delayed until 3 months post op which is typically when the period of intense immunosuppression is over. Splenectomy vaccine protocol for pediatric solid organ. Due to encapsulated bacteria such as streptococcus pneumoniae, haemophilus influenzae and neisseria meningitidis.
Therefore, prevention of opsi is extremely important for immunocompromised patients who have undergone splenectomy. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. There is no postsplenectomy syndrome reported by people who take aspirin yet. Postsplenectomy syndrome uf health, university of florida health. Splenosis is one type of ectopic splenic tissue the other being accessory spleen. Mild thrombocytosis may be observed after a splenectomy due to the lack of sequestering and destruction of platelets that would normally be carried out by the spleen. Post splenectomy syndrome can occur after surgery to remove the spleen. Laparoscopic splenectomy aftercare instructions what you. Definitionpostsplenectomy syndrome can occur after surgery to remove the spleen. Post splenectomy vaccine prophylaxis summary the splenectomized patient should be vaccinated to decrease the risk of overwhelming post splenectomy sepsis opss by organisms such as streptococcus pneumoniae, haemophilus influenzae type b, and neisseria meningitidis. Overwhelming post splenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period.
Vaccines are especially critical for people with chronic health conditions such as asplenia. Request pdf risk of infection and death among postsplenectomy patients. The greatest risk of mortality is in the first two years and is estimated at 50%. The outcome after treatment of venous thromboembolism is different in. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. Splenectomy is associated with a higher risk for venous. The removal of the spleen as a treatment method was initiated from the. The multiple complications of the asplenic condition, including severe sepsis. Complications of post splenectomy, especially intraabdominal hemorrhage can be fatal, with delayed or inadequate treatment having a high mortality rate. Patients who are asplenic or hyposplenic are at an increased risk for infection. The pathogenesis and risk of developing fatal opsi remain illdefined, however, especially in the normal adult host. Pdf fulminant, potentially lifethreatening infection represents a major. By combining the two evaluations, we found that approximately onethird 29%.
Patients should be educated prior to discharge on the risk of opss and their. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic. Therefore asplenic patients should be made aware of the need for early investigation and management of any febrile illness. Influenza vaccine each year to protect against seasonal flu. Overwhelming post splenectomy infection syndrome is a devastating complication that may affect almost a third of splenectomy cases within the first 10 years post surgery. Fever in a splenectomized patient infectious disease and. Additionally, we explored the use of a single number combining information. It consists of a group of symptoms and signs such as. Will you have postsplenectomy syndrome with aspirin ehealthme. Although relatively rare, it has a high mortality rate with delayed or inadequate treatment, and therefore it is important for emergency physicians to be familiar with. A noteworthy observation in our study was that opsi occurred later than previously estimated. Pdf prolonged survival after splenectomy in wiskott. The probability of thrombocytosis in patients who have had splenectomy is about 75. What are the possible side effects of a splenectomy.
Where a patient has had a splenectomy in the past, and has not received the required vaccines at the time, they should be immunised at the earliest possible opportunity. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Hyposplenic patients should be immunised as soon as the diagnosis is made. Management of postoperative complications following. The approach to a patient without a spleen must consider the underlying condition leading to splenectomy, preventative measures, and possible exposures 19,24. Prolonged survival after splenectomy in wiskottaldrich syndrome. A splenectomy does not cure myelofibrosis but may be performed to relieve pain caused by the swelling of the spleen. Older adults, especially those with cardiac or pulmonary disease, are more vulnerable to post surgical infections. Splenectomy was associated with an increased risk for inhospital vte development.
Abdominal splenosis is seen after abdominal trauma or surgery e. Splenectomy, hyposplenism and asplenia information page patient. Prompt management and aggressive treatment can alter the course of. E pidemiology a spleen is most commonly removed because of trauma where extensive damage and bleeding necessitates its removal. The major longterm risk of splenectomy is overwhelming postsplenectomy infection opsi. Vaccinations for people without a spleen what is the role of the spleen in my body. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms.
It also makes immune system cells, called lymphocytes, which help fight germs and infections. The infections are typically characterized by either meningitis or sepsis, and are caused by encapsulated organisms including streptococcus pneumoniae. A splenectomy is performed for the diagnosis andor treatment of different disease or to control symptoms associated with certain conditions, such as pain or bleeding. Reports of overwhelming postsplenectomy infection opsi began to. The spleens function is to store red blood cells and help remove old cells and other particles from circulation. Overwhelming postsplenectomy infection is a syndrome associated with a high. Postsplenectomy syndrome multimedia encyclopedia health.