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Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases.

Leone G, Pizzigallo E - Mediterr J Hematol Infect Dis (2015)

Bottom Line: Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients.This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria.At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria.

View Article: PubMed Central - PubMed

Affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma.

ABSTRACT
Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections.

No MeSH data available.


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Relative risk of infections after splenectomy with different matchings.
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f3-mjhid-7-1-e2015057: Relative risk of infections after splenectomy with different matchings.

Mentions: The distribution of microbial agents was similar between groups. Of note, encapsulated bacteria, such as pneumococci, meningococci, and H. influenzae, were rarely encountered in the splenectomized cohort, recently reported in the west countries.5,11 Similarly the adjusted relative risk (RR) and 95% confidence interval (CI) of death among splenectomized patients by indication, compared to the general population of Denmark, was the highest in the first 90 days, attaining a RR of 33-fold. However, although splenectomized patients have a high risk for infection, this risk is different in the various subgroups, and some degree seems due to underlying conditions and not to splenectomy alone. (Figure 3) The risk of death within the first 90 days ranges from 2,5% in patients splenectomized for ITP to 10% in patients with hemopoietic cancer or trauma.5 Older age can also be an important factor in increasing infection morbidity and mortality in the post-intervention period in elective splenectomy of hematologic patients.6,12


Bacterial Infections Following Splenectomy for Malignant and Nonmalignant Hematologic Diseases.

Leone G, Pizzigallo E - Mediterr J Hematol Infect Dis (2015)

Relative risk of infections after splenectomy with different matchings.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4621170&req=5

f3-mjhid-7-1-e2015057: Relative risk of infections after splenectomy with different matchings.
Mentions: The distribution of microbial agents was similar between groups. Of note, encapsulated bacteria, such as pneumococci, meningococci, and H. influenzae, were rarely encountered in the splenectomized cohort, recently reported in the west countries.5,11 Similarly the adjusted relative risk (RR) and 95% confidence interval (CI) of death among splenectomized patients by indication, compared to the general population of Denmark, was the highest in the first 90 days, attaining a RR of 33-fold. However, although splenectomized patients have a high risk for infection, this risk is different in the various subgroups, and some degree seems due to underlying conditions and not to splenectomy alone. (Figure 3) The risk of death within the first 90 days ranges from 2,5% in patients splenectomized for ITP to 10% in patients with hemopoietic cancer or trauma.5 Older age can also be an important factor in increasing infection morbidity and mortality in the post-intervention period in elective splenectomy of hematologic patients.6,12

Bottom Line: Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients.This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria.At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria.

View Article: PubMed Central - PubMed

Affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma.

ABSTRACT
Splenectomy, while often necessary in otherwise healthy patients after major trauma, finds its primary indication for patients with underlying malignant or nonmalignant hematologic diseases. Indications of splenectomy for hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication splenectomy except nonmalignant hematologic diseases. However, splenectomy, even if with different modalities including laparoscopic splenectomy and partial splenectomy, continue to be a current surgical practice both in nonmalignant hematologic diseases, such as Immune Thrombocytopenic Purpura (ITP), Autoimmune Hemolytic Anemia (AIHA), Congenital Hemolytic Anemia such as Spherocytosis, Sickle Cell Anemia and Thalassemia and Malignant Hematological Disease, such as lymphoma. Today millions of people in the world are splenectomized. Splenectomy, independently of its cause, induces an early and late increase in the incidence of venous thromboembolism and infections. Infections remain the most dangerous complication of splenectomy. After splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with polysaccharide and conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming infections due to capsulated bacteria. At present, most of infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of infections. So, splenectomy for malignant diseases has the major risk of infections.

No MeSH data available.


Related in: MedlinePlus