Overwhelming post-splenectomy infection in Hodgkin's disease: pathogenesis and prevention

After staging splenectomy, the risk of overwhelming sepsis in patients with Hodgkin's disease reaches 21% in certain subgroups. Youth, recent splenectomy and vigorous chemoradiotherapy predispose patients to this complication. Because of its explosive course and its known microbiology, post-splenectomy sepsis is better suited to prevention than to treatment. Since immunisation prior to treatment produces good antibody responses, all patients with Hodgkin's disease should probably be vaccinated against encapsulated bacteria at least 10 days prior to the onset of therapy.