Postsplenectomy infections in Danish children splenectomized 1969-1978

During the 10-year period 1969-1978 456 splenectomies in children 0-15 years old were registered in Denmark. The underlying disease in 56% was traumatic splenic rupture, in 20% hereditary spherocytosis, in 13% idiopathic thrombocytopenic purpura and in 11% various other diseases. Three hundred and eighty-four (84%) could be followed retrospectively for a mean period of 6.2 years after splenectomy. Twenty-one (5.5%) contracted bacteraemia or meningitis, in 15 (71%) caused by Streptococcus pneumoniae, and 6 (1.6%) died from the infection. The frequency of postsplenectomy infection (PSI) was lower in children with splenic rupture (2.5%) than in those with hereditary spherocytosis (4.9%), idiopathic thrombocytopenic purpura (11.5%) and Hodgkin's disease (13.8%). Sixteen percent of children splenectomized before the age of 4 years versus 4% above that age developed PSI. Ninety-five percent of the PSI cases occurred less than 6 years after splenectomy. The incidence of severe pneumococcal bacteraemia and pneumococcal meningitis in the splenectomized was 284 times that of non-splenectomized children.