Asplenia: Difference between revisions
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==Treatment== | ==Treatment== | ||
[[Asplenia medical treatment|Medical Therapy]] | [[ | [[Asplenia medical treatment|Medical Therapy]] | [[TAsplenia surgical techniques|Surgery]] | [[Asplenia interventions|Interventions]] | [[Asplenia primary prevention|Primary Prevention]] | [[Asplenia secondary prevention|Secondary Prevention]] | [[Asplenia cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Asplenia future or investigational therapies|Future or Investigational Therapies]] | ||
==Surgery== | ==Surgery== | ||
The mainstay of [[treatment]] for [[asplenia]] is [[medical therapy]] and [[prevention]].<ref name="pmid11253134">{{cite journal| author=Waghorn DJ| title=Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. | journal=J Clin Pathol | year= 2001 | volume= 54 | issue= 3 | pages= 214-8 | pmid=11253134 | doi=10.1136/jcp.54.3.214 | pmc=1731383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11253134 }} </ref> | The mainstay of [[treatment]] for [[asplenia]] is [[medical therapy]] and [[prevention]].<ref name="pmid11253134">{{cite journal| author=Waghorn DJ| title=Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. | journal=J Clin Pathol | year= 2001 | volume= 54 | issue= 3 | pages= 214-8 | pmid=11253134 | doi=10.1136/jcp.54.3.214 | pmc=1731383 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11253134 }} </ref> | ||
Revision as of 14:37, 19 July 2021
| Asplenia | |
| ICD-10 | D73.0, Q89.0 |
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| ICD-9 | 289.59, 759.01 |
| OMIM | 208530 %271400 208540 |
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Asplenia Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Asplenia On the Web |
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American Roentgen Ray Society Images of Asplenia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Synonyms and keywords:
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Asplenia from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Interventions | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Surgery
The mainstay of treatment for asplenia is medical therapy and prevention.[1]
Primary prevention
Vaccination
- Vaccination against these encapsulated bacteria is recommended to prevent asplenia patients from severe infection. Up to 87% of asplenic patients were found to have been infected with Streptococcus pneumoniae, one of the most common bacterial pathogen leading to infection in patients with asplenia.
- Vaccinations are also recommended before splenectomy and after the surgical removal. For those with functional asplenia or autosplenectomy, it is also advised to continue aggressive vaccination schedules. It is recommended that patients should be given the pneumococcal conjugate vaccine (PCV-13) 8 weeks in advance, as well as the pneumococcal polysaccharide vaccine (PPSV-23), Haemophilus influenzae type B vaccine (Hib), and the quadrivalent meningococcal conjugate vaccine 14 days before planned surgery for splenectomy.
- Apart from all these vaccines, patients should be encouraged to receive influenza vaccine, annual vaccination against the common strains of influenza.[2]
Antibiotic Prophylaxis
- Only Immunizations do not protect against infections with encapsulated bacteria, antibiotic prophylaxis Should be given.[3]
- For children
- All patients younger than five years of age should receive antibiotic prophylaxis.
- Birth to three months: Escherichia coli, Klebsiella are of concern in this age group.
- Amoxicillin or clavulanate 10 mg/kg/dose PO q12h, with penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose q12h, as an alternative if not tolerated.
- more than 3 months to five years
- Penicillin VK 125 mg per dose PO q12h OR amoxicillin 10 mg/kg/dose PO q12h.
- Liquid amoxicillin tastes better and may be better tolerated than liquid penicillin.
- more than 5 years
- Penicillin V 250 mg or 300 mg per dose q12h OR amoxicillin 250 mg per dose q12h.
- For penicillin, 250 mg is a convenient dose for suspension but tablets are only available as 300 mg
- For children
- The infectious risk in asplenic patients is high during their entire life but it is highest during the first 2 years following splenectomy and the risk decreases over time.[4]
- Along with vaccination, antibiotic prophylaxis should be given.
- Long term prophylactic therapy oral antibiotic penicillin V, or erythromycin in case of allergy, is required for at least 2 years after splenectomy to cover the period during which the infectious risk is highest.
Malaria Prophylaxis
- Asplenic and hyposplenic children must be advised of their increased risk of severe malaria and also take malaria prophylaxis as appropriate for their age and the type of malaria found in the area to which they are travelling and they should always seek travel advice.[5]
Secondary prevention
Effective measures for the secondary prevention of asplenia include:
- Patient should carry an alert card or bracelet and an up-to-date vaccination record.[6]
- Adult with asplenia, if unable to seek medical attention within 2 hours, should have access to preprescribed antibiotics which should be taken at fever onset.
- The risk of infection can be significantly reduced by using systematic, long-term approaches to care for asplenic patients.
- Patient and family education program that addresses the risk of infection in these at-risk patients.[7]
Case Studies
Template:Hematology Template:Phakomatoses and other congenital malformations not elsewhere classified
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- ↑ Waghorn DJ (2001). "Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed". J Clin Pathol. 54 (3): 214–8. doi:10.1136/jcp.54.3.214. PMC 1731383. PMID 11253134.
- ↑ Huebner ML, Milota KA (2015). "Asplenia and fever". Proc (Bayl Univ Med Cent). 28 (3): 340–1. doi:10.1080/08998280.2015.11929267. PMC 4462215. PMID 26130882.
- ↑ Salvadori MI, Price VE, Canadian Paediatric Society, Infectious Diseases and Immunization Committee (2014). "Preventing and treating infections in children with asplenia or hyposplenia". Paediatr Child Health. 19 (5): 271–8. PMC 4029242. PMID 24855431.
- ↑ Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C; et al. (2020). "Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016 : Care for the asplenic patient in general practice". BMC Fam Pract. 21 (1): 163. doi:10.1186/s12875-020-01237-3. PMC 7425533 Check
|pmc=value (help). PMID 32787857 Check|pmid=value (help). - ↑ Committee to Advise on Tropical Medicine and Travel (CATMAT) (2009). "Canadian recommendations for the prevention and treatment of malaria among international travellers--2009". Can Commun Dis Rep. 35 Suppl 1: 1–82. PMID 19750611.
- ↑ O'Neill NE, Baker J, Ward R, Johnson C, Taggart L, Sholzberg M (2020). "The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia". BMJ Open Qual. 9 (3). doi:10.1136/bmjoq-2019-000770. PMC 7410002 Check
|pmc=value (help). PMID 32759171 Check|pmid=value (help). - ↑ Lee GM (2020). "Preventing infections in children and adults with asplenia". Hematology Am Soc Hematol Educ Program. 2020 (1): 328–335. doi:10.1182/hematology.2020000117. PMC 7727556 Check
|pmc=value (help). PMID 33275684 Check|pmid=value (help).