Hyposplenism and Splenectomy

Medicine > Gastrointestinal

Background Knowledge 🧠

Definition

Hyposplenism: Reduced splenic function, leading to diminished immune response against certain pathogens.
Splenectomy: Surgical removal of the spleen.

Causes of Hyposplenism

Autoimmune conditions: e.g., Systemic lupus erythematosus (SLE), rheumatoid arthritis.
Haematological diseases: e.g., Sickle cell disease, thalassaemia, hereditary spherocytosis.
Infiltrative diseases: e.g., Sarcoidosis, amyloidosis.
Post-splenectomy.

Indications for Splenectomy

Trauma with splenic rupture.
Haematological conditions: e.g., Immune thrombocytopenia (ITP), hereditary spherocytosis.
Non-responsive splenomegaly.
Masses or cysts within the spleen.

Investigations 🧪

Investigations

Blood smear: Presence of Howell-Jolly bodies (nuclear remnants in RBCs) indicates hyposplenism.
Imaging: Ultrasound or CT scan for spleen size and morphology.

Management 🥼

Management

Vaccination: Before elective splenectomy, vaccinate against encapsulated organisms (pneumococcal, meningococcal, and H. influenzae type b vaccines).
Consider prophylactic antibiotics post-splenectomy, especially in children and for at least 2 years after surgery or lifelong in certain cases.
Education: Advise patients about the risk of infection and to seek immediate medical attention for febrile illnesses.

Prevention

Vaccination is key for preventing severe bacterial infections.
Routine check-ups to monitor for complications.
Prompt treatment of infections with broad-spectrum antibiotics.

Complications

Overwhelming post-splenectomy infection (OPSI): Severe infection due to encapsulated bacteria (e.g., Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis).
Thromboembolism: Increased risk of portal or mesenteric vein thrombosis.
Atelectasis and pneumonia: Due to restricted diaphragmatic movement post-surgery.
Wound infection.

Key Points

Hyposplenism leads to a diminished immune response.
Multiple aetiologies, such as post-splenectomy.
Investigations include blood smear to detect hyposplenism and imaging of the spleen.
Management involves vaccination, prophylactic antibiotics and patient education, which are crucial to reduce complications, such as OPSI, post-splenectomy.

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