Tuesday, May 2, 2017

Infection in the Splenectomy Patient

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."