Splenectomy

Question 1

A 19 year old man has an emergency splenectomy after a motor vehicle accident. What are the important short-term and long-term management issues to consider?

Answer 1

Impression
Spleen is a highly vascular organ, and plays an important immunological function, as well as red cell clearance. Splenectomy in the setting of trauma can have a number of short- and long-term implications for the patient that requiring a number of management inputs

Question 2

Short-term implications

Answer 2

Short term
High risk of bleeding initially:

• FBC q8hrly due to blood loss (looking for evidence of anaemia, usually a lag in FBC results for this)
• then regular FBC as patients are likely to have a thrombocytosis (peaks day 20 and then +/- resolves
• chest physio to prevent pneumonia given abdominal splinting from height of the surgical procedure
• DVT prophylaxis can start 24 hrs post-operative
• MVA, therefore patient requires a tertiary survey to identify and treat any other injuries that may be present

Question 3

Long-term implications

Answer 3

Long term

• patient + family education: lifelong change, increased risks of infection, importance of vaccination, prophylactic ABx post-operatively, alert bracelets, importance of keeping a low threshold for medical assessment. increased risk of
• registration with splenectomy Australia
• consider wearing a medic-alert bracelet
• referral to haematologist for post-splenectomy care, may require anti-platelet therapy if they get marked thrombocytosis
• Vaccination: pneumococcal, H Influenzae, meningococcal, annual flu shots, all age-appropriate vaccinations. vaccinations are usually done 2-4 weeks post-splenectomy, unless suspected poor adherence and should be vaccinated before leaving hospital.
• Prophylactic ABx: daily PO amoxicillin for 1st year,
• supply of emergency/crisis ABx for any fevers/flu’s that may arise so can start treatment immediately, requires pre-surgical ABx
• Travel: always see GP before travelling OS to inform on appropriate infective precautions and required vaccinations
• Animal education: any animal or insect bites must present for emergency assessment (esp dog or tic bites).