Hyposplenism
| Asplenia | |
|---|---|
| Classification and external resources | |
| Specialty | medical genetics |
| ICD-10 | D73.0, Q89.0 |
| ICD-9-CM | 289.59, 759.01 |
| OMIM | 208530 %271400 208540 |
| eMedicine | ped/150 radio/58 |
| Patient UK | Asplenia |
Asplenia refers to the absence of normal spleen function and is associated with some serious infection risks. Hyposplenism is used to describe reduced ('hypo-') splenic functioning, but not as severely affected as with asplenism.
In an effort to preserve some of the spleen's protective roles, attempts are now often made to preserve a small part of the spleen when performing either surgical subtotal (partial) splenectomy, or partial splenic embolization. This may be particularly important in poorer countries where protective measures for patients with asplenia are not available. However, it has been advised that preoperative vaccination is advisable until the remnant splenic tissue can reestablish its function.
Asplenia is a form of immunodeficiency, increasing the risk of sepsis from polysaccharide encapsulated bacteria, and can result in overwhelming post splenectomy infection (OPSI), often fatal within a few hours. In particular, patients are at risk from , Haemophilus influenzae, and meningococcus. The risk is elevated as much as 350–fold.
The risk to asplenic patients has been expressed as equivalent to an adult dying in a road traffic accident (in every 100 people without spleens, 1 to 5 would develop a severe infection per decade) (reference UK Splenectomy Trust Advice)—hence sensible precautions are advisable.Increased platelet counts can be seen in individuals without a functioning spleen.
To minimise the risks associated with splenectomy, antibiotic and vaccination protocols have been established, but are often poorly adhered to by physicians and patients due to the complications resulting from antibiotic prophylaxis such as development of an overpopulation of Clostridium difficile in the intestinal tract.
Because of the increased risk of infection, physicians administer oral antibiotics as a prophylaxis after a surgical splenectomy (or starting at birth, for congenital asplenia or functional asplenia).
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