Hyposplenism / splenectomy

Question 1

Causes of hyposplenism

Answer 1

• splenectomy
• sickle-cell
• coeliac disease, dermatitis herpetiformis
• Graves’ disease
• systemic lupus erythematosus
• amyloid

Question 2

Features of hyposplenism

Answer 2

Howell-Jolly bodies

Siderocytes

Question 3

Following splenectomy: most common complication?

Answer 3

particularly at risk from Pneumococcus, Haemophilus, Meningococcus and Aapnocytophaga canimorsus infections

Question 4

Antibiotics prophylaxis

Answer 4

penicillin V: unfortunately clear guidelines do not exist of how long antibiotic prophylaxis should be continued. It is generally accepted though that penicillin should be continued for at least 2 years and at least until the patient is 16 years of age, although the majority of patients are usually put on antibiotic prophylaxis for life

Question 5

Indications for a splenectomy

Answer 5

• Trauma: 1/4 are iatrogenic
• Spontaneous rupture: EBV
• Hypersplenism: hereditary spherocytosis or elliptocytosis etc
• Malignancy: lymphoma or leukaemia
• Splenic cysts, hydatid cysts, splenic abscesses

Question 6

Elective splenectomy

Answer 6

• Elective splenectomy is a very different operation from that performed in the emergency setting. The spleen is often large (sometimes massive)
• Most cases can be performed laparoscopically. The spleen will often be macerated inside a specimen bag to facilitate extraction.

Question 7

Complications of splenectomy

Answer 7

• Haemorrhage (may be early and either from short gastrics or splenic hilar vessels
• Pancreatic fistula (from iatrogenic damage to pancreatic tail)
• Thrombocytosis: prophylactic aspirin
• Encapsulated bacteria infection e.g.Strep. pneumoniae,Haemophilus influenzaeandNeisseriameningitidis

Question 8

Post-splenectomy changes

Answer 8

• Platelets will rise first (therefore in ITP should be given after splenic artery clamped)
• Blood film will change over following weeks, Howell-Jolly bodies will appear
• Other blood film changes include target cells and Pappenheimer bodies
• Increased risk of post-splenectomy sepsis, therefore prophylactic antibiotics and pneumococcal vaccine should be given.