Postsplenectomy acute glomerulonephritis due to a chronic. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood. Medical complications following splenectomy sciencedirect. A report also suggested that splenectomy could have triggered progression to aml in one case of mds, 11 and splenectomy could increase the risk of blastic transformation in agnogenic.
The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. Pdf the spleen is an intraperitoneal organ that performs vital hematological and immunological functions. Prior to that, treatment of hcvassociated thrombocytopenia was an important and unresolved problem9,10. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Prolonged survival after splenectomy in wiskottaldrich. Post splenectomy infections are potentially severe with overwhelming post splenectomy infection opsi and this justifies preventive measures prophylactic antibiotics, appropriate immunizations, patient education and demands prompt antibiotic management with thirdgeneration cephalosporins for any post splenectomy fever. Postsplenectomy syndrome definition of postsplenectomy. The spleen is an important part of the bodys defense immune system.
The patient was successfully treated with intravenous ceftriaxone. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic. We report a case of severe evans syndrome after a liver transplant. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming postsplenectomy infection opsi. It may develop immediately or as late as 65 years postsplenectomy 24. Opsi is a syndrome of fulminant sepsis occurring in. Medical complications following splenectomy emconsulte. Prevention and management of overwhelming postsplenectomy. Due to decreased response to encapsulated bacteria, the principal bacteria involved in postsplenectomy sepsis are primarily streptococcus pneumoniae 50% to 70%, and neisseria meningitidis and. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. However, recognition and clinical management of opsi is not well established. Successful treatment of evans syndrome post liver transplant with splenectomy and switch from tacrolimus to cyclosporine.
Postsplenectomy syndrome can occur after surgery to remove the spleen. The diagnosis was initially unrecognized in all patients and was confused with biliary. To assess the frequency of splenic vein thrombosis svt after splenectomy and its consequences on patient treatment. Splenectomy vaccination and antimicrobial prophylaxis. Partial splenectomy is a form of splenic salvage and refers to the removal of a portion of the spleen based upon its segmental blood supply. Splenectomy may be followed by severe systemic infection because such surgery removes the splenic macrophages that filter and phagocytose bacteria and other bloodborne. Prompt management and aggressive treatment can alter the course of. Cureus neisseria cinerea in a postsplenectomy patient. The risk of overwhelming infection postsplenectomy remains lifelong and is highest in immunocompromised patients. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms.
The utility of splenectomy as rescue treatment for severe acute antibody. The major longterm complication of splenectomy is opsi, also known as postsplenectomy sepsis syndrome, which is defined as a. The splenectomy can also be considered as a therapeutic option. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. In individuals with neutropenia and felty syndrome who have recurrent lifethreatening bacterial infections, splenectomy is the treatment of choice, though the response is often short lived. Overwhelming postsplenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. Background open splenectomy is performed in two major clinical scenarios. Reports of overwhelming postsplenectomy infection opsi began to. Learn about postsplenectomy syndrome, find a doctor, complications, outcomes, recovery and followup care for postsplenectomy syndrome. Late septic complications in adults following splenectomy for trauma. Management of overwhelming postsplenectomy infection syndrome. Postsplenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive. Opsi cases have been well documented, and more recently the.
Hematology a constellation of findings that follow splenectomy, which are most marked in the erythroid series, as the spleen is responsible for pitting and culling effete or. Preventing severe infection after splenectomy the bmj. The major longterm complication of splenectomy is opsi, also known as post splenectomy sepsis syndrome, which is defined as a generalized nonspecific flulike prodrome followed by rapid deterioration to fullblown fulminant septic shock within 2448 hours of the onset. Splenectomy lifelong precautions what is a splenectomy. What are other complications related to splenectomy. Coincidental splenectomy in chronic fatigue syndrome. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. The duration of antimicrobial prophylaxis should be assessed foreach. Splenectomy is a surgical procedure to remove your spleen. Laparoscopic splenectomy is surgery to take out all or a part of your spleen.
Because splenectomy may cause portal hypertension, which leads to intrapulmonary shunting, portal hypertension plays a role in the development of the hepatopulmonary syndrome in. An overwhelming postsplenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. The patient had a twoyear history of cfs prior to her involvement in a road crash. Management of postoperative complications following.
Role of splenectomy in the treatment of myelodysplastic. Our case confirms that prolonged survival can be achieved postsplenectomy in patients with was, given that there is a systematic approach in their postsplenectomy medical care. Asplenia is a form of immunodeficiency, increasing the risk of sepsis from polysaccharide encapsulated bacteria, and can result in overwhelming post splenectomy infection opsi, often fatal within a few. Opsi is a rapidly progressive fulminant infection linked to spontaneous. It consists of a group of symptoms and signs such as. Overwhelming postsplenectomy infection opsi is a serious fulminant process that carries a high mortality rate24. Overwhelming postsplenectomy infection opsi is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flulike syndrome to a fulminant, potentially. The spleen is in the uppermost area of the left side of the abdomen, just under the. The most critical action in the treatment of opsi is the immediate use of broad spectrum i.
Riley, md, and jedda rupert, md, eglin air force base family medicine residency, eglin air force base, florida l eukocytosis, often defined as an ele. Splenectomyinduced portal hypertension and pulmonary. The spleen plays a role in immunity against bacterial infections. Splenectomized patients, in fact, have a significant higher infection risk, with an incidence of overwhelming postsplenectomy infection syndrome reported of 15 %, with a mortality rate of 3870. Partial splenectomy leaves behind role of splenectomy for. Overwhelming postsplenectomy infection syndrome in adults a. Overwhelming postsplenectomy infection opsi is a serious disease that. Patients who are asplenic or hyposplenic are at an increased risk for infection. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. Evidencebased information on post splenectomy prophylaxis from hundreds of trustworthy sources for health and social care. Treatment of postsplenectomy thrombotic complications. Complications of splenectomy the american journal of medicine. A unique case of coincidental splenectomy for trauma during chronic fatigue syndrome cfs is presented. According to the reasons for splenectomy, 14 patients with postsplenectomy hemorrhage were grouped into two groups.
The full text of this article is available in pdf format. A splenectomy is an operation to remove the spleen. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic or hyposplenic individuals that is associated with high mortality and morbidity. Risk of infection and death among postsplenectomy patients. This is the first case ever of neisseria cinerea bacteremia in a postsplenectomy patient and ninth case overall. Overwhelming postsplenectomy infection syndrome in adults. The clinical course of feltys syndrome compared to matched controls. Postsplenectomy syndrome information mount sinai new york.66 202 70 787 134 559 761 861 1137 1012 1589 135 1609 404 130 880 1114 123 1631 1334 1038 279 64 565 850 64 553 1066 744 88 951 187 401 1316 738 497 864