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Post-splenectomy sepsis

From Dr Vivek Shrivastva, medical SHO, Royal Sussex County Hospital

I would like to remind readers regarding management of

post-splenectomy sepsis, in view of two patients I have seen on acute take over the past eight months. Recognising the need to treat patients at risk from overwhelming post-splenectomy sepsis (OPSI) is crucial, as most deaths occur within 24 hours of admission to hospital.

The urgency for aggressive treatment was highlighted

by a recent acute admission.

A 37-year-old woman had a splenectomy at 12 years of age for hereditary spherocytosis, and had received appropriate immunisations but had never taken antibiotic prophylaxis.

She developed a sore throat and was given antibiotics by her GP. Unfortunately her condition deteriorated and she was admitted to hospital the following day with a tonsillitis resulting in a profound acidosis and clinical features

of overwhelming sepsis syndrome. She was transferred to the intensive care unit where she made an uneventful recovery.

Patients deemed at risk require early intervention, and admission to hospital for systemic antibiotic therapy is strongly advised in this population.

The prevalence of OPSI is low (about 0.5 per cent of splenectomised patients), but

it carries a mortality of up to

80 per cent. Patients are at most risk from encapsulated organisms. The British Committee for Standards in Haematology (2002) recommends pneumococcal, Hib, men C and flu vaccines as prophylaxis.

Again, the need to inform patients of the risk posed to them is essential and although a source of contention, lifelong penicillin prophylaxis should be considered.

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