emDocs - May 1, 2017 - Authors: Weerasuriya D and Stettner E
Edited by: Koyfman A and Long B
"Pearls and Pitfalls
- Ask all patients with a surgical scar near their spleen if they had a splenectomy.
- Consider treating patients who are at risk for functional asplenia as if they are asplenic (for example, patients with hemoglobinopathies or bone marrow transplants).
- Ask what antibiotics, steroids, and vaccines they have received recently.
- Even if an asplenic patient is afebrile in the emergency department, but reports a fever at home, consider performing a complete sepsis work up in the emergency department.
- Asplenic patients are at increased risk for encapsulated organisms, parasites, DIC, and meningitis.
- Evaluate for DIC prior to performing a lumbar puncture, if one is indicated.
- Streptococcus pneumoniae is still the most common cause of sepsis and death in these patients.
- Asplenic patients have little reserve and high mortality. Give antibiotics and start aggressive hypotension management early."