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Perth Haematology :: Dr Steven Ward

Splenectomy

 

PROTOCOL: Splenectomy & Infection

 

Main risk following splenectomy is severe infection.

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greatest risk for children

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commonest infection is Steptococcus pneumoniae (pneumococcal sepsis)

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risk of death from severe infection in normal people (with spleen) is 1 in 30,000 per year. After splenectomy risk is 8 x for adults; 50 x for children.
(or: Of 100 people without a spleen, 1-5 of them would develop severe infection over 10 years).

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Risk seems greatest in childhood and for 2 years after splenectomy - but lifelong continued risk

 

Reducing the risk of infection

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Vaccination: against the common bacteria causing problems in the post-splenectomy setting:

 

Agent

Vaccine

Timing

Booster

Pneumococcus

(Strep pneumoniae)

 23 valent polysaccharide vaccine (Pneumovax 23) sc or im

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2 weeks before splenectomy OR

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14 days after

Every 5 years

Meningococcus (Neisseria mengingitidis)

C

Meningococcal C conjugate vaccine (menjugate, Meningitec, NeisVAc-C) im

C vaccine 1st then ACWY 6-8 weeks later

 

C NIL

 

ACWY

Meingococcal quadrivalent polysacchardie ACWY vaccine (Mencevax ACWY, Menomune) sc

Wait 6 months for C if ACWY given first

ACWY every 5 years

Haemophilus influenzae Type B

HiB (Liquid Pedvax HIB, Hiberix) im

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2 weeks before splenectomy OR

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14 days after

NIL

Influenza

Influenza vaccine

Pre-winter

Annual

 

 

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Regular (prophylactic) antibiotics:
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 Penicillin V 250mg bd (125mg if <6 years old)

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If penicillin allergy: erythromycin 250mg bd or roxithromycin 150mg/day

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? stop after age 16 or 2 years after splenectomy in adults

 

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Emergency antibiotic supply
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Alternative to (or in addition to) prophylactic Antibiotic

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Home supply of: Amoxycillin 3g; or erythromycin 1g qid; or roxithromycin 300mg/d if fever ensues take 1 dose

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And seek medical advice

 

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Caution with minor infections:
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Advise to seek medical help at onset of infection

 

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Precautions against malaria:
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avoid mosquito bites (repellants; nets; DEET; long sleeves)

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 anti-malaria prophylaxis (tablets)

 

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Education of family and Medic-Alert bracelet