Asplenic patient - Revision history

ClaireLewis at 23:43, 30 September 2019

2019-09-30T23:43:27Z

← Older revision		Revision as of 23:43, 30 September 2019
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	===Presentation===		===Presentation===
	*Sickle-cell disease patient over the age of 8		*Sickle-cell disease patient over the age of 8
	*~~absent~~ spleen on CT		*Absent spleen on CT
	*~~otherwise~~ asplenic patient		*Otherwise asplenic patient

	===Asplenia increases risk of (and worsens course of)===		===Asplenia increases risk of (and worsens course of)===
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	*[[Sepsis]]/septicemia		*[[Sepsis]]/septicemia
	*[[Babesiosis]], [[Ehrlichiosis]]		*[[Babesiosis]], [[Ehrlichiosis]]
	*Infections from encapsulated bacteria (e.g. [[Strep ~~Pneumo~~]], [[H. influenzae]], ~~Neiserria Meningitidis~~)		*Infections from encapsulated bacteria (e.g. [[Strep pneumo]], [[H. influenzae]], [[Neisseria meningitidis]])
	*Viral illnesses		*[[viral syndrome\|Viral illnesses]]

	===Signs/symptoms of infection===		===Signs/symptoms of infection===
	*[[~~cough~~]], [[fever]], rigors, malaise		*[[Cough]], [[fever]], rigors, malaise
	*[[~~nausea~~/vomiting]], [[constipation]]/[[diarrhea]]		*[[Nausea/vomiting]], [[constipation]]/[[diarrhea]]
	*~~urinary~~ symptoms		*[[dysuria\|Urinary symptoms]]
	*wound infection		*wound infection
	*[[~~rash~~]]		*[[Rash]]
	**increased oxygen requirement, tachycardia		*[[Hypoxia\|Increased oxygen requirement]], [[tachycardia]]

	==Differential Diagnosis==		==Differential Diagnosis==
	*Bacterial infection ([[sepsis]])		*[[bacterial disease\|Bacterial infection]] ([[sepsis]])
	**[[Streptococcus]] pneumonia		**[[Streptococcus]] pneumonia
	**[[Haemophilus influenzae]] type B		**[[Haemophilus influenzae]] type B
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	**[[Capnocytophaga canimorsus]]		**[[Capnocytophaga canimorsus]]
	**[[Bordetella holmesii]]		**[[Bordetella holmesii]]
	*Viral illness		*[[Viruses\|Viral illness]]

	[[File:Asplenia.jpg\|thumb\|CT of an asplenic patient]]		[[File:Asplenia.jpg\|thumb\|CT of an asplenic patient]]
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	===Workup===		===Workup===
	*CBC (elevated WBC, platelets)		*CBC (elevated WBC, platelets)
	*BMP, lactate		*BMP, [[lactate]]
	*[[CXR]]		*[[CXR]]
	*Blood cultures, urine, wound cultures		*Blood cultures, urine, wound cultures
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	**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)		**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

	===Vaccination management===		===[[Vaccination]] management===
	*4 doses of PCV13 before 15 months		*4 doses of PCV13 before 15 months
	*PPSV23 at least 8 weeks after last PCV13, first at age 2		*PPSV23 at least 8 weeks after last PCV13, first at age 2

ClaireLewis at 14:46, 1 September 2019

2019-09-01T14:46:32Z

← Older revision		Revision as of 14:46, 1 September 2019
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	**Previous hypersplenism		**Previous hypersplenism
	**[[Sickle cell disease]]		**[[Sickle cell disease]]
	**[[Immune thrombocytopenic purpura]]		**[[Immune thrombocytopenic purpura]], [[TTP]], [[autoimmune hemolytic anemia]]
	**[[Hodgkin's lymphoma]]		**[[Hodgkin's lymphoma]]
	**[[Thalassemia]]		**[[Thalassemia]]
	**[[Hereditary spherocytosis]]		**[[Hereditary spherocytosis]]
	**Splenic rupture/hemorrhage		**[[Splenic injury]] (rupture/hemorrhage)
	*Functional		*Functional
	**[[Sickle cell disease]]		**[[Sickle cell disease]]

Mholtz: Text replacement - " bid " to " BID "

2017-07-07T10:15:04Z

Text replacement - " bid " to " BID "

← Older revision		Revision as of 10:15, 7 July 2017
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	===[[Fever]] (no sepsis)===		===[[Fever]] (no sepsis)===
	*treat empirically with antibiotics		*treat empirically with antibiotics
	**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 ~~bid~~ for adults		**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 BID for adults
	**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg ~~bid~~ for adults		**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg BID for adults
	**[[levofloxacin]] 750 mg once daily (adults or adolescents only)		**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
	**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)		**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)

Rossdonaldson1: Text replacement - "CXR" to "CXR"

2016-09-09T15:34:37Z

Text replacement - "*CXR" to "*CXR"

← Older revision		Revision as of 15:34, 9 September 2016
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	*CBC (elevated WBC, platelets)		*CBC (elevated WBC, platelets)
	*BMP, lactate		*BMP, lactate
	*CXR		*[[CXR]]
	*Blood cultures, urine, wound cultures		*Blood cultures, urine, wound cultures
	*Peripheral blood smear		*Peripheral blood smear

ClaireLewis at 23:20, 7 September 2016

2016-09-07T23:20:44Z

← Older revision		Revision as of 23:20, 7 September 2016
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	<references/>		<references/>

	[[Category:~~Hematology and Oncology~~]] [[Category:~~Infectious Disease~~]]		[[Category:Heme/Onc]] [[Category:ID]]

ClaireLewis at 23:18, 7 September 2016

2016-09-07T23:18:06Z

← Older revision		Revision as of 23:18, 7 September 2016
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	==References==		==References==
	<references/>		<references/>

			[[Category:Hematology and Oncology]] [[Category:Infectious Disease]]

ClaireLewis: /* Asplenia increases risk of (and worsens course of) */

2016-09-05T16:10:26Z

Asplenia increases risk of (and worsens course of)

← Older revision		Revision as of 16:10, 5 September 2016
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	*[[Pneumonia]]		*[[Pneumonia]]
	*[[Sepsis]]/septicemia		*[[Sepsis]]/septicemia
	*Infections from encapsulated bacteria		*[[Babesiosis]], [[Ehrlichiosis]]
			*Infections from encapsulated bacteria (e.g. [[Strep Pneumo]], [[H. influenzae]], Neiserria Meningitidis)
	*Viral illnesses		*Viral illnesses

ClaireLewis at 16:01, 5 September 2016

2016-09-05T16:01:03Z

← Older revision		Revision as of 16:01, 5 September 2016
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	===Causes of asplenia===		===Causes of asplenia===
	*Congenital		*Congenital
	*~~Surgical~~		*Prior splenectomy for:
	**Previous hypersplenism		**Previous hypersplenism
	**[[Sickle cell disease]]		**[[Sickle cell disease]]
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	*Functional		*Functional
	**[[Sickle cell disease]]		**[[Sickle cell disease]]

	~~===Asplenia increases risk of (and worsens course of)===~~
	*[[Pneumonia]]
	*[[Sepsis]]/septicemia
	*Infections from encapsulated bacteria
	*Viral diseases

	==Clinical Features==		==Clinical Features==
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	*otherwise asplenic patient		*otherwise asplenic patient

	===~~If Septic~~===		===Asplenia increases risk of (and worsens course of)===
	*Nonspecific symptoms		*[[Pneumonia]]
	**[[~~cough~~]]		*[[Sepsis]]/septicemia
	**[[~~fever~~]]		*Infections from encapsulated bacteria
	**~~increasing oxygen requirement~~		*Viral illnesses
	**malaise
	**[[~~rash~~]]		===Signs/symptoms of infection===
	**[[nausea/vomiting]]		*[[cough]], [[fever]], rigors, malaise
	**[[constipation]]/[[diarrhea]]		*[[nausea/vomiting]], [[constipation]]/[[diarrhea]]
	**urinary symptoms		*urinary symptoms
	**~~rigors~~		*wound infection
	*~~wound infection (perhaps from dog bite)~~		*[[rash]]
			**increased oxygen requirement, tachycardia

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*CBC		*CBC (elevated WBC, platelets)
	*BMP		*BMP, lactate
	*CXR		*CXR
	*Blood cultures x2		*Blood cultures, urine, wound cultures
	*UA w/ culture
	*Wound culture, ~~if present~~
	*Peripheral blood smear		*Peripheral blood smear
	**Howell Jolly bodies		**Howell Jolly bodies
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	**Pappenheimer bodies		**Pappenheimer bodies
	**Target cells		**Target cells
	**Increased WBCs
	**Increased platelets

	[[file:Splenectomyblood - Edited.jpg\|thumb\|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells.]]		[[file:Splenectomyblood - Edited.jpg\|thumb\|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells.]]
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	===[[Fever]] (no sepsis)===		===[[Fever]] (no sepsis)===
	*treat empirically with ~~broad spectrum~~ antibiotics		*treat empirically with antibiotics
	**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults		**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
	**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults		**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults

Jwcombs at 00:51, 5 September 2016

2016-09-05T00:51:39Z

← Older revision		Revision as of 00:51, 5 September 2016
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	==Disposition==		==Disposition==
	*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)		*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)
			*Consider admitting asplenic patients presenting with fever

	==See Also==		==See Also==

ClaireLewis: /* Causes of asplenia */

2016-09-04T21:35:01Z

Causes of asplenia

← Older revision		Revision as of 21:35, 4 September 2016
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	**[[Thalassemia]]		**[[Thalassemia]]
	**[[Hereditary spherocytosis]]		**[[Hereditary spherocytosis]]
			**Splenic rupture/hemorrhage
	*Functional		*Functional
	**[[Sickle cell disease]]		**[[Sickle cell disease]]