Care of the Asplenic Patient

• Published in: The New England journal of medicine Vol. 371; no. 4; pp. 349 - 356
• Main Authors: Rubin, Lorry G, Schaffner, William
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 24.07.2014
• Subjects: Biological and medical sciences; Children; Fever; General aspects; Influenza; Medical sciences; Medical treatment; Meningitis; Pneumonia; Prophylaxis; Sepsis; Septicemia; Sickle cell anemia; Spleen; Splenectomy; Vaccines; United States > US; Human; Medicine
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMcp1314291

Asplenic patients are at risk for rapidly progressive septicemia and death. Such patients should be vaccinated against pneumococci, H. influenzae type b, meningococci, and influenza virus, and if fever develops, they should receive empirical antimicrobial therapy immediately. Foreword This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage A 23-year-old man sustained abdominal trauma in a motorcycle accident that required a surgical splenectomy. He received the 23-valent pneumococcal polysaccharide vaccine (PPSV23) after surgery. Six months after his surgery, he calls his primary care provider because he has fever. What is the appropriate management? Are other prophylactic measures available and indicated? The Clinical Problem Mortality among patients with postsplenectomy sepsis can be as high as 50%. Most commonly caused by Streptococcus pneumoniae, this infection often has a sudden onset and a fulminant course. The clinical presentation is nonspecific, with a very short prodromal period of fever, chills, sore . . .