Management Asplenia

1 management

1.1 antibiotic prophylaxis
1.2 vaccinations
1.3 travel measures
1.4 additional measures

management

to minimise risks associated splenectomy, antibiotic , vaccination protocols have been established, poorly adhered physicians , patients due complications resulting antibiotic prophylaxis such development of overpopulation of clostridium difficile in intestinal tract.

antibiotic prophylaxis

because of increased risk of infection, physicians administer oral antibiotics prophylaxis after surgical splenectomy (or starting @ birth, congenital asplenia or functional asplenia).

those asplenia cautioned start full-dose course of antibiotics @ first onset of upper or lower respiratory tract infection (for example, sore throat or cough), or @ onset of fever.

vaccinations

it suggested splenectomized persons receive following vaccinations, , ideally prior planned splenectomy surgery:

pneumococcal polysaccharide vaccine (not before 2 years of age). children may first need 1 or more boosters of pneumococcal conjugate vaccine if did not complete full childhood series.
haemophilus influenzae type b vaccine, if not received in childhood. adults have not been vaccinated, 2 doses given 2 months apart advised in new 2006 uk vaccination guidelines (in uk may given combined hib/menc vaccine).
meningococcal conjugate vaccine, if not received in adolescence. vaccinated adults require single booster , non-immunised adults advised, in uk since 2006, have 2 doses given 2 months apart. children young conjugate vaccine should receive meningococcal polysaccharide vaccine in interim.
influenza vaccine, every winter, prevent getting secondary bacterial infection.

travel measures

in addition normal immunizations advised countries visited, group meningococcus should included if visiting countries of particular risk (e.g. sub-saharan africa). non-conjugated meningitis , c vaccines used purpose give 3 years coverage , provide less-effective long-term cover meningitis c conjugated form mentioned.

those lacking functional spleen @ higher risk of contracting malaria, , succumbing effects. travel malarial areas carry greater risks , best avoided. travellers should take appropriate anti-malarial prophylaxis medication , vigilant on measures prevent mosquito bites.

the pneumococcal vaccinations may not cover of other strains of pneumococcal bacteria present in other countries. likewise antibiotic resistance may vary, requiring different choice of stand-by antibiotic.

additional measures

surgical , dental procedures - antibiotic prophylaxis may required before surgical or dental procedures.
animal bites - adequate antibiotic cover required after minor dog or other animal bites. asplenic patients particularly susceptible infection capnocytophaga canimorsus , should receive five-day course of amoxicillin/clavulanate (erythromycin in patients allergic penicillin).
tick bites - babesiosis rare tickborne infection. patients should check or have inspected tick bites if in at-risk situation. presentation fever, fatigue, , haemolytic anaemia requires diagnostic confirmation identifying parasites within red blood cells on blood film , specific serology. quinine (with or without clindamycin) effective treatment.
alert warning - people without working spleen can carry card, or wear special bracelet or necklet says not have working spleen. alert healthcare professional take rapid action if become ill , cannot notify them of condition.




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^ guidelines prevention , treatment of infection in patients absent or dysfunctional spleen (pdf). wilton, cork, ireland: health service executive, southern area. september 2002.