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Immune response after splenectomy

J L Sullivan, H D Ochs, G Schiffman

    Lancet (London, England)
    |January 28, 1978
    PubMed
    Summary
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    Patients with asplenia show reduced immune responses to bacteriophage phiX 174 but respond well to pneumococcal polysaccharide vaccines. Vaccination is recommended for asplenic individuals to prevent infections.

    Area of Science:

    • Immunology
    • Microbiology

    Background:

    • The spleen plays a crucial role in the immune response, particularly against encapsulated bacteria.
    • Individuals with anatomical or functional asplenia are at increased risk for severe infections, especially from Streptococcus pneumoniae.

    Purpose of the Study:

    • To investigate the immune response to bacteriophage phiX 174 and pneumococcal polysaccharide vaccine in patients with asplenia.
    • To assess the impact of asplenia on primary and secondary antibody responses.
    • To evaluate the efficacy of pneumococcal polysaccharide vaccination in asplenic populations.

    Main Methods:

    • Studied 31 patients with anatomical or functional asplenia.
    • Administered bacteriophage phiX 174 intravenously and tridecavalent pneumococcal polysaccharide vaccine subcutaneously.

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  • Measured antibody responses, including primary and secondary antibody production (IgM to IgG switch) and seroconversion rates.

    • Main Results:

    • Asplenic patients had significantly decreased primary antibody responses to phiX 174, though clearance was normal.
    • Secondary antibody responses to phiX 174 were quantitatively normal, but lacked the typical IgM to IgG switch.
    • Most asplenic groups, excluding those with Hodgkin's disease, showed significant seroconversion to pneumococcal polysaccharide antigens.
    • Asplenic patients without Hodgkin's disease exhibited robust antibody increases to most pneumococcal antigens, comparable to controls.

    Conclusions:

    • Asplenia impairs specific aspects of the immune response to bacteriophage phiX 174.
    • Pneumococcal polysaccharide vaccination is effective in inducing protective antibody levels in most asplenic patients.
    • Given the high risk of Streptococcus pneumoniae infections, pneumococcal polysaccharide vaccination is strongly recommended for all individuals with anatomical or functional asplenia.