Post by kickingfrog on Feb 7, 2011 10:44:38 GMT
From Patient UK site :
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PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Splenectomy, Hyposplenism and Asplenia
The spleen is involved in producing protective humoral antibodies, the production and maturation of B and T cells and plasma cells, removal of unwanted particulate matter (e.g. bacteria) and also acts as a reservoir for blood cells, especially white cells and platelets.
Splenectomy
Splenectomy may occur in three different ways:
Planned, where prophylactic measures can be used to prevent later complications
Traumatic, due to an accident or during surgery
Autosplenectomy, which refers to the physiological loss of spleen function (hyposplenism), e.g. associated with sickle cell anaemia (chronic damage to the spleen results in atrophy),
coeliac disease, dermatitis herpetiformis, essential thrombocythaemia and ulcerative colitis
......
Causes of hyposplenism
....
Functional hyposplenism: sickle cell anaemia (HbSS, HbSC), thalassaemia major, essential thrombocythaemia, and lymphoproliferative diseases (Hodgkin's and non-Hodgkin's Lymphoma, CLL),
Coeliac disease, .....
........
Complications of hyposplenism
Fulminant, potentially life-threatening infection is a major long-term risk of hyposplenism yet such infection is largely preventable.
Most common infection is pneumococcal infection (mortality up to 60%), followed by H. influenzae type b (less common but significant in children), and N. meningitidis. ....
Management
Recently updated guidelines recommend the following:1
All splenectomised patients and those with functional hyposplenism should receive pneumococcal immunisation and patients not previously immunised should receive Haemophilus Influenza type b vaccine.
Patients not previously immunised should receive Meningococcal Group C conjugate vaccine.
Influenza immunisation should be given. ..
...
Patient records should be clearly labelled to indicate the underlying risk of infection. Vaccination and re-vaccination status should be clearly and adequately documented.
...
All vaccines (including live vaccines) can be given safely to children or adults with an absent or dysfunctional spleen.
Pneumococcal vaccination
...
Children under two years of age have a reduced ability to mount an antibody response to polysaccharide antigens and are, therefore, at particular risk of vaccine failure. The newer conjugate 7-valent vaccine produces better response in the under 2's so should be used where available in this age group and in other individuals at particularly high risk.2
HIB vaccination
All unimmunised patients should receive Haemophilus Influenza Type B vaccine (re-vaccination is not currently recommended).
Meningococcal vaccination
All unimmunised patients should receive Meningococcal C conjugate vaccine, a course of 3 doses for infants, 2 for children (4-12 months) and single dose for older children and adults (further re-vaccination of Meningococcal C is not currently recommended).
Vaccine should be given pre-splenectomy in the unimmunised.
In UK prevalence of type A is low. In other parts of the world cover for Group A would be wise (so patients will need additional Meningococcal A & C combined vaccine prior to foreign travel).
Protection afforded by plain polysaccharide A and C vaccine is short lived. Immunisation of hyposplenic individuals who have previously received the plain polysaccharide A and C vaccine with Meningococcal C conjugate vaccine is, therefore, recommended.
Influenza vaccination
Annual Influenza vaccination is recommended.[/b
....
Document references
Davies JM et al; Guidelines for the prevention and treatment of infections in patients with an absent or dysfunctional spleen, British Committee for Standards in Haematology (2002).
Finn A, Booy R, Moxon R, et al; Should the new pneumococcal vaccine be used in high-risk children? Arch Dis Child. 2002 Jul;87(1):18-21. [abstract]
Kyaw MH, Holmes EM, Chalmers J, et al; A survey of vaccine coverage and antibiotic prophylaxis in splenectomised patients in Scotland. J Clin Pathol. 2002 Jun;55(6):472-4. [abstract]
Waghorn DJ; Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol. 2001 Mar;54(3):214-8. [abstract]
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 1057
Document Version: 21
DocRef: bgp24811
Last Updated: 18 May 2008
Review Date: 18 May 2010
www.patient.co.uk/showdoc/40024811/
**************************
********************************
PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.
Splenectomy, Hyposplenism and Asplenia
The spleen is involved in producing protective humoral antibodies, the production and maturation of B and T cells and plasma cells, removal of unwanted particulate matter (e.g. bacteria) and also acts as a reservoir for blood cells, especially white cells and platelets.
Splenectomy
Splenectomy may occur in three different ways:
Planned, where prophylactic measures can be used to prevent later complications
Traumatic, due to an accident or during surgery
Autosplenectomy, which refers to the physiological loss of spleen function (hyposplenism), e.g. associated with sickle cell anaemia (chronic damage to the spleen results in atrophy),
coeliac disease, dermatitis herpetiformis, essential thrombocythaemia and ulcerative colitis
......
Causes of hyposplenism
....
Functional hyposplenism: sickle cell anaemia (HbSS, HbSC), thalassaemia major, essential thrombocythaemia, and lymphoproliferative diseases (Hodgkin's and non-Hodgkin's Lymphoma, CLL),
Coeliac disease, .....
........
Complications of hyposplenism
Fulminant, potentially life-threatening infection is a major long-term risk of hyposplenism yet such infection is largely preventable.
Most common infection is pneumococcal infection (mortality up to 60%), followed by H. influenzae type b (less common but significant in children), and N. meningitidis. ....
Management
Recently updated guidelines recommend the following:1
All splenectomised patients and those with functional hyposplenism should receive pneumococcal immunisation and patients not previously immunised should receive Haemophilus Influenza type b vaccine.
Patients not previously immunised should receive Meningococcal Group C conjugate vaccine.
Influenza immunisation should be given. ..
...
Patient records should be clearly labelled to indicate the underlying risk of infection. Vaccination and re-vaccination status should be clearly and adequately documented.
...
All vaccines (including live vaccines) can be given safely to children or adults with an absent or dysfunctional spleen.
Pneumococcal vaccination
...
Children under two years of age have a reduced ability to mount an antibody response to polysaccharide antigens and are, therefore, at particular risk of vaccine failure. The newer conjugate 7-valent vaccine produces better response in the under 2's so should be used where available in this age group and in other individuals at particularly high risk.2
HIB vaccination
All unimmunised patients should receive Haemophilus Influenza Type B vaccine (re-vaccination is not currently recommended).
Meningococcal vaccination
All unimmunised patients should receive Meningococcal C conjugate vaccine, a course of 3 doses for infants, 2 for children (4-12 months) and single dose for older children and adults (further re-vaccination of Meningococcal C is not currently recommended).
Vaccine should be given pre-splenectomy in the unimmunised.
In UK prevalence of type A is low. In other parts of the world cover for Group A would be wise (so patients will need additional Meningococcal A & C combined vaccine prior to foreign travel).
Protection afforded by plain polysaccharide A and C vaccine is short lived. Immunisation of hyposplenic individuals who have previously received the plain polysaccharide A and C vaccine with Meningococcal C conjugate vaccine is, therefore, recommended.
Influenza vaccination
Annual Influenza vaccination is recommended.[/b
....
Document references
Davies JM et al; Guidelines for the prevention and treatment of infections in patients with an absent or dysfunctional spleen, British Committee for Standards in Haematology (2002).
Finn A, Booy R, Moxon R, et al; Should the new pneumococcal vaccine be used in high-risk children? Arch Dis Child. 2002 Jul;87(1):18-21. [abstract]
Kyaw MH, Holmes EM, Chalmers J, et al; A survey of vaccine coverage and antibiotic prophylaxis in splenectomised patients in Scotland. J Clin Pathol. 2002 Jun;55(6):472-4. [abstract]
Waghorn DJ; Overwhelming infection in asplenic patients: current best practice preventive measures are not being followed. J Clin Pathol. 2001 Mar;54(3):214-8. [abstract]
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 1057
Document Version: 21
DocRef: bgp24811
Last Updated: 18 May 2008
Review Date: 18 May 2010
www.patient.co.uk/showdoc/40024811/
**************************