Asplenic patient

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Background

Causes of asplenia

Asplenia increases risk of (and worsens course of)

  • Pneumonia
  • Sepsis/septicemia
  • Infections from encapsulated bacteria
  • Viral diseases

Clinical Features

CBC & Blood smear

  • Howell Jolly bodies
  • Heinz Bodies
  • Pappenheimer bodies
  • Target cells
  • Increased WBCs
  • Increased platelets

Presentation

  • Sickle-cell disease patient over the age of 8
  • absent spleen on CT
  • otherwise asplenic patient

If Septic

  • Nonspecific symptoms
    • cough
    • fever
    • increasing oxygen requirement
    • malaise
    • rash
    • nausea/vomiting
    • constipation/diarrhea
    • urinary symptoms
    • rigors
  • wound infection (perhaps from dog bite)

Differential Diagnosis

Workup

  • blood smear
  • CBC
  • BMP
  • CXR
  • x2 blood cultures
  • UA w/ culture
  • wound infection cultures
  • additional imaging as necessary

Management

Sepsis

  • 30mL/kg fluids
  • broad spectrum antibiotics appropriate for suspected infection

Fever (no sepsis)

  • treat empirically with broad spectrum antibiotics
    • amoxicillin-clavulanate: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
    • cefuroxime: 30mg/kg per day in children divided into two doses; 500mg bid for adults
    • levofloxacin 750 mg once daily (adults or adolescents only)
    • moxifloxacin 400 mg once daily (adults or adolescents only)
    • gemifloxacin 320 mg once daily (adults or adolescents only)

Vaccination management

  • 4 doses of PCV13 before 15 months
  • PPSV23 at least 8 weeks after last PCV13, first at age 2
  • 2nd dose of PPSV23 3 years after first
    • (if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
    • (if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
    • (if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
  • Redose PPSV23 every 5 years
  • Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
  • inactivated influenza vaccine yearly
  • Neisseria meningitidis vaccine for asplenic adults

Prophylaxis

  • Daily Penicillin VK or amoxicillin
  • for children up to age of 5 or for 1 year following splenectomy
  • potentially up to age of 18 for highly immunocompromised individuals

Disposition

  • to appropriate level of care for presenting illness
  • asplenia not an indication for admission

See Also

External Links

References