Asplenic patient: Difference between revisions
(Created page with "==Background== ===Causes of asplenia=== *Congenital *Surgical **Previous hypersplenism **Sickle cell disease **Immune thrombocytopenic purpura **Hodgkin's Lymphoma **Thalassem...") |
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*Surgical | *Surgical | ||
**Previous hypersplenism | **Previous hypersplenism | ||
**Sickle cell disease | **[[Sickle cell disease]] | ||
**Immune thrombocytopenic purpura | **[[Immune thrombocytopenic purpura]] | ||
**Hodgkin's | **[[Hodgkin's lymphoma]] | ||
**Thalassemia | **[[Thalassemia]] | ||
**Hereditary spherocytosis | **[[Hereditary spherocytosis]] | ||
*Functional | *Functional | ||
**Sickle cell disease | **[[Sickle cell disease]] | ||
===Asplenia increases risk of (and worsens course of)=== | ===Asplenia increases risk of (and worsens course of)=== | ||
*Pneumonia | *[[Pneumonia]] | ||
*Sepsis/septicemia | *[[Sepsis]]/septicemia | ||
*Infections from encapsulated bacteria | *Infections from encapsulated bacteria | ||
*Viral diseases | *Viral diseases | ||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Bacterial infection (sepsis) | *Bacterial infection ([[sepsis]]) | ||
**Streptococcus pneumonia | **[[Streptococcus]] pneumonia | ||
**Haemophilus influenzae type B | **[[Haemophilus influenzae]] type B | ||
**Neisseria meningitidis | **[[Neisseria meningitidis]] | ||
**Capnocytophaga canimorsus | **[[Capnocytophaga canimorsus]] | ||
*Viral illness | *Viral illness | ||
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==Management== | ==Management== | ||
===Sepsis=== | ===[[Sepsis]]=== | ||
*30mL/kg fluids | *30mL/kg fluids | ||
*broad spectrum antibiotics appropriate for suspected infection | *broad spectrum antibiotics appropriate for suspected infection | ||
===Fever (no sepsis)=== | ===[[Fever]] (no sepsis)=== | ||
*treat empirically with broad spectrum antibiotics | *treat empirically with broad spectrum 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) | ||
**gemifloxacin 320 mg once daily (adults or adolescents only) | **[[gemifloxacin]] 320 mg once daily (adults or adolescents only) | ||
===Vaccination management=== | ===Vaccination management=== | ||
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===Prophylaxis=== | ===Prophylaxis=== | ||
*Daily Penicillin VK or amoxicillin | *Daily [[Penicillin VK]] or [[amoxicillin]] | ||
*for children up to age of 5 or for 1 year following splenectomy | *for children up to age of 5 or for 1 year following splenectomy | ||
*potentially up to age of 18 for highly immunocompromised individuals | *potentially up to age of 18 for highly immunocompromised individuals | ||
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==References== | ==References== | ||
Lorry G. Rubin, M.D., and William Schaffner, M.D. Care of the Asplenic Patient. | *Lorry G. Rubin, M.D., and William Schaffner, M.D. Care of the Asplenic Patient. N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291. | ||
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291. | *http://www.nejm.org/doi/full/10.1056/NEJMcp1314291 | ||
http://www.nejm.org/doi/full/10.1056/NEJMcp1314291 | |||
<references/> | <references/> | ||
Revision as of 15:38, 31 August 2016
Background
Causes of asplenia
- Congenital
- Surgical
- Previous hypersplenism
- Sickle cell disease
- Immune thrombocytopenic purpura
- Hodgkin's lymphoma
- Thalassemia
- Hereditary spherocytosis
- Functional
Asplenia increases risk of (and worsens course of)
Clinical Features
CBC & Blood smear
- Howell Jolly bodies
- Heinz Bodies
- Pappenheimer bodies
- Target cells
- Increased WBCs
- Increased platelets
Presentation
- Sickle-cell disease patient over the age of 8
- absent spleen on CT
- otherwise asplenic patient
If Septic
- Nonspecific symptoms
- cough
- fever
- increasing oxygen requirement
- malaise
- rash
- nausea/vomiting
- constipation/diarrhea
- urinary symptoms
- rigors
- wound infection (perhaps from dog bite)
Differential Diagnosis
- Bacterial infection (sepsis)
- Viral illness
Workup
- blood smear
- CBC
- BMP
- CXR
- x2 blood cultures
- UA w/ culture
- wound infection cultures
- additional imaging as necessary
Management
Sepsis
- 30mL/kg fluids
- broad spectrum antibiotics appropriate for suspected infection
Fever (no sepsis)
- treat empirically with broad spectrum antibiotics
- 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
- levofloxacin 750 mg once daily (adults or adolescents only)
- moxifloxacin 400 mg once daily (adults or adolescents only)
- gemifloxacin 320 mg once daily (adults or adolescents only)
Vaccination management
- 4 doses of PCV13 before 15 months
- PPSV23 at least 8 weeks after last PCV13, first at age 2
- 2nd dose of PPSV23 3 years after first
- (if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
- (if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
- (if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
- Redose PPSV23 every 5 years
- Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
- inactivated influenza vaccine yearly
- Neisseria meningitidis vaccine for asplenic adults
Prophylaxis
- Daily Penicillin VK or amoxicillin
- for children up to age of 5 or for 1 year following splenectomy
- potentially up to age of 18 for highly immunocompromised individuals
Disposition
- to appropriate level of care for presenting illness
- asplenia not an indication for admission
See Also
External Links
References
- Lorry G. Rubin, M.D., and William Schaffner, M.D. Care of the Asplenic Patient. N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291.
- http://www.nejm.org/doi/full/10.1056/NEJMcp1314291