Page 162 - Essential Haematology

148 / Chapter 10 Spleen

Pappenheimer bodies (siderotic granules on iron is seen particularly in children under the age of 5

staining; Fig. 10.2 ). The most frequent cause is sur- years and those with sickle cell anaemia. Th e most
gical removal of the spleen (e.g. after traumatic characteristic susceptibility is to encapsulated bac-
rupture) but hyposplenism can also occur in sickle teria such as Streptococcus pneumoniae , Haemophilus
cell anaemia, gluten - induced enteropathy, infl am- infl uenzae type B and Neisseria meningitidis .
matory bowel disease and splenic arterial thrombo- Streptococcus pneumoniae is a particular concern and
sis (Table 10.2 ). can cause a rapid and fulminant disease. Malaria
tends to be more severe in splenectomized individu-
Splenectomy als. Measures to reduce the risk of serious infection
include the following:
Surgical removal of the spleen may be indicated for
treatment of haematological disorders as well as
1 The patient should be informed about the

after splenic rupture or for splenic tumours or cysts
increased susceptibility to infection and advised
(Table 10.3 ). Splenectomy can be performed by
to carry a card about their condition. Th ey should
open abdominal laparotomy or by laparoscopic
be counselled about the increased risk of infec-
surgery.
tion on foreign travel, including that from

The platelet count can often rise dramatically
malaria and tick bites.
in the early postoperative period, reaching levels of 2 Prophylactic oral penicillin is recommended
9
up to 1000 × 10 /L and peaking at 1 – 2 weeks.
for life. Erythromycin may be prescribed for
Thrombotic complications are seen in some patients

patients allergic to penicillin. A supply of tablets
and prophylactic aspirin or heparin are often
may also be given to the patient to take in the
required during this period. Long - term alterations
event of onset of fever before medical care is
in the peripheral blood cell count may also be seen,
available.
including a persistent thrombocytosis, lymphocyto-
3 Vaccination against pneumococcus, haemo-
sis or monocytosis.
philus, meningococcus and infl uenza infection
Prevention of i nfection in is recommended (Table 10.4 ). All types of
vaccine, including live vaccines, can be given
h yposplenic p atients
safely to hyposplenic individuals although
Patients with hyposplenism are at lifelong increased the immune response to vaccination may be
risk of infection from a variety of organisms. Th is impaired.

Table 10.4 Recommendations for vaccination of patients with hyposplenism.
Revaccination
Vaccine Time of vaccination schedule Comments
1 Pneumoccal polyvalent If possible, at least 2 5 yearly Assessment of

vaccine weeks prior to antibody response
splenectomy may be useful

2 Combined Haemophilus Alternatively, 2 weeks Not required Not required if
infl uenzae type b conjugate post - splenectomy for all Not required previously vaccinated
and meningococcal C three vaccines
conjugate
3 Infl uenza As soon as available for Annual Inactivated subunit

seasonal protection vaccine