• Clinical science

Asplenia

Abstract

The spleen is primarily responsible for the elimination of damaged erythrocytes and plays a central role in the opsonization and removal of encapsulated organisms from the bloodstream. Asplenia is the absence of normal spleen function (functional asplenia) or of the spleen itself (anatomic asplenia). Anatomic asplenia is most commonly due to elective or emergency splenectomy, while functional asplenia is due to conditions that result in the loss of splenic function (e.g., multiple infarctions in sickle cell disease). Asplenic patients typically have Howell-Jolly bodies on peripheral blood smears as well as neutrophilia and thrombocytosis. Patients with asplenia have a lifelong risk of fulminant, life-threatening infections. Asplenic sepsis and overwhelming postsplenectomy sepsis have a very poor prognosis. Therefore, preventive measures including immunization against encapsulated bacteria and early empiric antibiotic treatment for fever are vital.

Etiology

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Hematologic changes in asplenic patients

The lack of Howell-Jolly bodies in asplenic patients is suggestive of the presence of an accessory spleen!
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Infection in asplenic patients

An asplenic patient with fever requires immediate empiric antibiotic treatment. Asplenic infection and sepsis are a medical emergency! Preventing the infection is vital (see “Management of asplenic patients” below)!
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Management of asplenic patients

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