SURGICAL

Splenectomy

  • Usual acute post-operative care, including supportive care and monitoring for post-operative complications
  • Specific management required for post-splenectomy patients (see below)
  • In Victoria, Australia, patients can be placed on a Splenectomy Registry to help ensure appropriate followup
  • Immunisation (boosted every 5 years)
    • Pneumococcal
    • HiB
    • Meningococcal C
    • Influenza
  • Prophylactic antibiotics (advice largely based on data from children with sickle cell anaemia, little evidence in adults)
    • e.g. amoxicillin
  • children less than 5 years of age with sickle cell anaemia (functionally asplenic)
  • at least 3 years following splenectomy (some experts advise no antibiotics in an otherwise well adult)
  • asplenic patients with severe underlying immunosuppression
  • at least 6 months after an episode of severe sepsis in asplenic patients
  • Fever management
    • must have a prescription for empiric antibiotics ASAP (e.g. amoxicillin-clavulanate, cefuroxime, moxifloxacin, ceftriaxone)
    • must seek medical attention ASAP
  • Advice
    • Asplenic patients should carry a medical alert and an up-to-date vaccination card
    • Asplenic patients require specific advice on travel as they are at increased risk of severe malaria (mosquitoes) and babeosis (tick bites) in endemic areas
    • Asplenic patients require specific advice about animal handling as OPSS (due to Capnocytophaga canimorsus) may result from dog, cat or other animal bites
  • Other
    • post-splenectomy thrombocytopenia
    • usually transient but can be marked
    • If >1,000 x 10e9/uL Aspirin 100mg daily po

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