• Clinical science

Asplenia

Summary

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

Hematologic changes in asplenic patients

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

Infection in asplenic patients

General

  • Increased risk of fulminant and life-threatening infections and sepsis for up to 30 years or longer after splenectomy

Overwhelming postsplenectomy infection (OPSI) and asplenic sepsis

Asplenic individuals Have No Spleen: H. influenzae, N. meningitidis, and S. pneumonia are the pathogens that most commonly cause asplenic sepsis.

An asplenic patient with fever requires immediate empiric antibiotic treatment. Asplenic infection and sepsis are a medical emergency. Preventing the infection is vital.

Management of asplenic patients

General measures

  • Patient identification card or Medic Alert® bracelet/necklace
  • Take precautions to avoid dog and tick bites
  • Caution is recommended when travelling to malaria-endemic areas

Infection prevention [3]

Thrombosis prevention

  • 1. Mahlaoui N, Minard-Colin V, Picard C, Bolze A, Ku CL, Tournilhac O, Gilbert-Dussardier B, Pautard B, Durand P, Devictor D, Lachassinne E, Guillois B, Morin M, Gouraud F, Valensi F, Fischer A, Puel A, Abel L, Bonnet D, Casanova JL. Isolated congenital asplenia: a French nationwide retrospective survey of 20 cases. The Journal of pediatrics. 2011; 158(1): pp. 142–8, 148.e1. doi: 10.1016/j.jpeds.2010.07.027.
  • 2. Morgan TL, Tomich EB. Overwhelming Post-Splenectomy Infection (OPSI): A Case Report and Review of the Literature. J Emerg Med. 2012; 43(4): pp. 758–763. doi: 10.1016/j.jemermed.2011.10.029.
  • 3. Gillis S, Dann EJ, Berkman N, Koganox Y, Kramer MR. Fatal Haemophilus influenzae Septicemia Following Bronchoscopy in a Splenectomized Patient. Chest. 1993; 104(5): pp. 1607–1609. doi: 10.1378/chest.104.5.1607.
last updated 10/19/2020
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