Management of the post-splenectomy patient

Splenectomy and post-splenectomy complications are a common topic in the SAQs. Specific details have been explored in Question 18 from the second paper of 2007. There are two main issues of management: one, of asplenic immunosuppression, and two- of protection from post-splenecotmy thrombocytosis.

Thrombosis after splenectomy has an incidence of about 5%, and can be managed wth either aspirin or (in extreme circumstances) with hydroxyurea.

Guidelines for vaccination of post-splenectomy patients

The vaccinations prevent severe infection by encapsulated organisms - because the encapsulated organisms are poorly opsonised by complement, and the spleen was the only organ which could remove them. Thus, one must protect this patient from these bugs. There has been a 2011 revision of the guidelines for such prophylaxis:

• The asplenic patients should carry an identifying card
• They should receive the following vaccinations:
  • Pneumococcal vaccination
  •  Haemophilus influenzae type b conjugate vaccine
  • Meningococcal conjugate vaccine (B, C)
  • Influenza immunization
• There may be some role for lifelong prophylactic antibiotics
• The patient should have a supply of antibiotics for emergency use at home

Features of splenctomy on the FBC

• Howel-Jolly bodies
• Anisocytosis
• Thrombocytosis
• Acanthocytosis
• Target cells
• Pappenheimer bodies
• Platelet aggregates