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[Antiinfectious prophylaxis in asplenia]
S W Eber1, B H Belohradsky, M Weiss
1Abt. Immunol./Hämotol./Onkol., Univ.-Kinderklinik Zürich, Zurich, Switzerland. stefan.eber@kispi.unizh.ch
Insights
Children without a spleen face a high risk of severe infections, primarily from Streptococcus pneumoniae. Vaccinations and antibiotic prophylaxis are crucial, and splenectomy indications in children should be carefully considered.
Area of Science:
- Pediatric Medicine
- Immunology
- Hematology
Background:
- Asplenia in children can be congenital or acquired, with hereditary spherocytosis being a common reason for splenectomy.
- Patients without a spleen have a significantly increased risk of severe postsplenectomy infections, particularly those caused by Streptococcus pneumoniae.
Purpose of the Study:
- To outline the risks associated with childhood asplenia and emphasize preventive strategies.
- To discuss current recommendations for vaccinations and antibiotic prophylaxis in asplenic children.
- To re-evaluate the indications for splenectomy in pediatric hematologic conditions.
Main Methods:
- Review of existing literature on childhood asplenia, postsplenectomy infections, and management strategies.
- Analysis of vaccination protocols and antibiotic prophylaxis guidelines.
- Discussion of the evolving landscape of pneumococcal resistance and its impact on treatment.
Main Results:
- Asplenic children require vaccinations against pneumococci, Haemophilus influenzae, and meningococci.
- Continuous antibiotic prophylaxis for at least three years post-splenectomy is recommended, with lifelong intervention for unclear infections.
- Penicillin resistance in pneumococci may limit future prophylaxis options, necessitating restricted splenectomy indications.
Conclusions:
- Splenectomy in childhood should be reserved for hematologic diseases with moderate to severe symptoms.
- Preserving splenic remnants after trauma is advisable.
- Further research is needed on the efficacy of partial splenectomy in managing hemolysis and preventing infections.
Abstract:
Asplenia in childhood may be congenital (e.g. Ivemark-syndrome) or acquired (functional hyposplenism in sickle cell disease; after splenectomy or bone marrow transplantation). Hereditary spherocytosis is the most common indication for splenectomy in childhood. Virtually every patient without spleen has a significantly increased risk of severe postsplenectomy infection (mostly caused by Streptococcus pneumoniae). Therefore, vaccinations against pneumococci, haemophilus influenzae and, under certain circumstances, meningococci are recommended. In addition a continuous prophylaxis with antibiotics should be performed for at least three years (or even longer depending on the disease) after splenectomy followed by lifelong interventional application of broad spectrum antibiotics in case of any unclear infection or high fever. This prophylaxis must be started as early as four months of age in sickle cell disease. In future the use of penicillin may be hampered by the growing resistance of pneumococci. Due to this fact the indication for splenectomy in childhood should be restricted to patients with hematologic disease (spherocytosis and other hemolytic anemias, chronic ITP etc.) and moderate to severe symptoms. It is unclear whether partial splenectomy for spherocytosis (and other hemolytic anemias) is an alternative regarding both longlasting reduction of hemolysis and prevention of severe infection. After trauma every effort should be undertaken to preserve a splenic remnant.