Updated: 1/10/2019

Asplenia

Topic
Review Topic
0
0
Questions
1
0
0
Snapshot
  • A 13-year-old girl presents to her primary care physician for follow-up care of her recently diagnosed hereditary spherocytosis. She reports increasing fatigue and shortness of breath. She required a blood transfusion approximately 4 months prior to presentation. She has not received the PCV13 vaccine but has received the PPSV23 vaccine on year ago. Physical examination shows pallid conjunctiva and organomegaly in the left upper quadrant. Laboratory testing is significant for an elevated reticulocyte count and serum bilirubin. A decision has been made among the patient, her family, and physician to undergo an elective splenectomy. She is administred the PCV13 vaccine 14-days before her operation.
Introduction
  • Clinical definition
    • absence of normal spleen function that can be secondary to
      • surgical splenic removal
      • congenital absence or abnormally reduced spleen
      • splenic infarction such as in
        • sickle cell disease and thrombosis of the splenic artery
      • splenic infiltration such as in
        • sarcoidosis, malignancy, and amyloidosis
  • Under normal conditions
    • the spleen is involved in
      • filtering the blood through a series of capillaries, which results in
        • the removal of rigid erythrocytes
        • ingestion of circulating bacteria
    • the spleen is a lymphoid organ that contains
      • B-lymphocytes which is involved in
        • producing opsonizing antibodies against foreign materials which is vital for
          • eliminated encapsulated organisms
  • Patients with absent splenic function are therefore
    • at risk of infection by encapsulated organisms such as
      • Streptococcus pneumoniae (most important)
      • Haemophilus influenzae
      • Neisseria meningitidis
    • other infectious agents include
      • Capnocytophaga canimorsus
        • patients are at risk when exposed to dogs
      • Babesia
Presentation
  • Physical exam
    • in cases of sepsis
      • toxic appearing
      • tachycardia
      • evolving hypotension
      • altered sensorium
Studies
  • Labs
    • blood smear will show
      • Howell-Jolley bodies
      • target cells
    • complete blood cell count (CBC) can show
      • leukocytosis
      • thrombocytosis
Treatment
  • Conservative
    • immunization
      • indication
        • should be administered at least two weeks before a scheduled splenectomy
        • should be administered two weeks after splenectomy in patients who
          • were not able to receive pre-operative immunization
      • modality
        • PCV13 and PPSV23 is recommended for both adults and children
  • Medical
    • antibiotic prophylaxis 
      • indication
        • this is the mainstay and initial treatment for infection prophylaxis in asplenic patients
        • children should receive daily antibiotic prophylaxis (amoxicillin or penicillin VK) until
          • the age of five and
            • at least one year post-splenectomy
        • must be taken when fever or rigors is present in asplenic patients since this is
          • can be a warning sign for fulminant bacteremia
          • antibiotics include
            • amoxicillin-clavulanate or cefuroxime in children
            • fluoroquinolone (e.g., levofloxacin) in adults
Complications
  • Sepsis due to
    • infection by encapsulated organisms
 

Please rate topic.

Average 3.3 of 7 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
Calculator

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
ARTICLES (1)
Topic COMMENTS (6)
Private Note