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[Asplenia and DIC (author's transl)].

G Mitterstieler, H Haas, R Resch

Padiatrie Und Padologie

|January 1, 1979

Summary

Children undergoing splenectomy face high risks of severe septic shock, often caused by pneumococci. Prophylactic measures like penicillin, pneumococcal immunization, and spleen preservation are crucial to reduce mortality in these vulnerable patients.

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Area of Science:

Pediatric Surgery
Infectious Diseases
Hematology

Background:

Splenectomy, the surgical removal of the spleen, is performed for various pediatric conditions.
The spleen plays a vital role in immune function, particularly against encapsulated bacteria.

Observation:

Three cases of severe septic shock in children with impaired splenic function (congenital hyposplenia or post-splenectomy) are presented.
Two cases involved pneumococcal septicemia and consumption coagulopathy, with one fatality.
A follow-up of 44 splenectomized children revealed 5 cases of acute septicemia or probable sepsis with disseminated intravascular coagulation (DIC) within an average of 1.2 years post-surgery.

Findings:

Septic shock in asplenic children can lead to severe disseminated intravascular coagulation (DIC).
The mortality rate from sepsis in splenectomized children (8%) is comparable to that of their primary conditions.
Pneumococci were identified as a common pathogen in these severe infections.

Implications:

Urgent need for effective infection prophylaxis in asplenic children.
Recommended prophylactic strategies include penicillin prophylaxis, active immunization with pneumococcal antigens, and spleen preservation when feasible.
Spleen preservation should be prioritized to mitigate the risk of overwhelming post-splenectomy infection (OPSI).

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