Splenectomy

Question 1

Emergency splenectomy indications?

Answer 1

1) Trauma
2) rupture (e.g. EBV infection)
3) hypersplenism (hereditary spherocytosis)
4) malignancy (lymphoma or leukaemia
5) splenic cyst, hyatid cyst, splenic abscess

Question 2

Elective splenectomy indications?

Answer 2

1) haemolytic anaemia (hereditary or immune)

2) idiopathic thrombocytopenic purpura (ITP)

Question 3

What organisms are post-splenectomy patients susceptible to?

Answer 3

Encapsulated organisms:

• haemophilus
• pneumococcus (highest risk)
• meningococcus
• Capnocytophaga canimorsus

Question 4

What vaccines are given to post-splenectomy patients?

Answer 4

1) pneumococcal vaccine - boosters every 5 years
2) influenza - yearly
3) Hib - one-off
4) meningitis - one-off

Question 5

Other prophylactic management?

Answer 5

Antibiotics: typically amoxicillin or penicillin V (erythromycin if allergic)

Question 6

Optimal time to give pneumococcal vaccine if patient undergoes elective splenectomy?

Answer 6

2 weeks before surgery (BNF)

Question 7

When are splenectomy patients most at risk of infection?

Answer 7

First 2 years post-splenectomy

Question 8

Blood film findings post-splenectomy/hyposplenism?

Answer 8

• Howell Jolly bodies
• Siderocytes (granules)
• Target cells
• Pappenheimer bodies
• acanthocytes

Question 9

Hyposplenism is commonly associated with what condition?

Answer 9

Coeliac disease

Question 10

What is infectious mononucleosis?

Answer 10

Glandular fever –> viral infection caused by EBV (HHV-4)

Question 11

How is infectious mononucleosis transmitted?

Answer 11

Saliva (‘kissing disease’)

Question 12

Presentation of glandular fever?

Answer 12

• Mild in young children
• Young adults (classic triad):
• -> Fever
• -> Sore throat
• -> Enlarged lymph nodes in neck

–> fatigue - lasts months

Other signs:

• pharyngitis, enlarged tonsils w/ pus
• petechiae palate
• splenomegaly (50%)
• hepatitis (transient rise ALT)
• lymphocytosis / haemolytic anaemia

Question 13

Potential complications of glandular fever?

Answer 13

splenomegaly, hepatomegaly

Question 14

Management of EBV?

Answer 14

Supportive - hydrate, rest, analgesia (paracetamol)

Question 15

Advice to prevent ruptured spleen?

Answer 15

Avoid heavy lifting & contact sports for 1 month

Question 16

Antibiotic to avoid?

Answer 16

Amoxicillin (EBV maculopapular rash)

Question 17

Infectious causes of widespread maculopapular rash?

Answer 17

Enterovirus and echovirus infection (e.g. hand foot and mouth disease)
Parvovirus B19 infection (erythema infectiosum)
Roseola infantum
Epstein Barr virus infection
Cytomegalovirus (CMV) infection
HIV seroconversion illness
Secondary syphilis
Acute hepatitis B/C infection
Measles
Rubella
Meningococcemia
Scarlet fever
Staphylococcal scalded skin syndrome
Kawasaki disease
Juvenile onset or adult onset Still disease

Question 18

Diagnosis of EBV?

Answer 18

• Clinical

- NICE recommends heterophil antibody test (Monospot test) + FBC in 2nd week to confirm diagnosis

Question 19

How is lymphadenopathy different fro EBV vs. tonsillitis?

Answer 19

Tonsillitis - typically ONLY upper anterior cervical chain

EBV - possible in anterior and posterior triangle of neck