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ASPLENIA ABSENCE OF THE SPLEEN
Category: Pediatric Surgery
Abstract : The absence of the spleen (asplenia) occurs after surgical removal, following chronic conditions or congenital. Trauma is the most common cause of removing the spleen in children and sickle cell disease is the most common cause of functional asplenia in children. Congenital absence of the spleen is usually associated with serious malformations, primarily cardiovascular and abdominal heterotaxia. T
The absence of the spleen (asplenia) occurs after surgical removal, following chronic conditions or congenital. Trauma is the most common cause of removing the spleen in children and sickle cell disease is the most common cause of functional asplenia in children. Congenital absence of the spleen is usually associated with serious malformations, primarily cardiovascular and abdominal heterotaxia.
The spleen contributes importantly to the normal and pathologic removal of blood cells from the circulation and to defense against infection with encapsulated bacteria. Asplenia increases the risk of fulminant bacteremia (post-splenectomy sepsis) and mortality with these organisms. This risk is also increased by the underlying condition that caused the removal of the spleen, i.e., trauma, malignancy or hematologic disease. Several recommendations have been given when dealing with an asplenic individual. These are to vaccinate the child against pneumococcus (Pneumovax vaccine), hemophilus influenza type b and meningococcus. Regarding Pneumovax use revaccination after 3-5 years is recommended for children with asplenia who are 10 years of age or younger and for older children and adults who were immunized at least five years before. Duration of vaccine-induced antibodies is unknown but may be shorter than that in normal persons. Long-term antimicrobial prophylaxis is also used. This carries the problem of compliance and for how long. Significant febrile episodes should be managed aggressively, and probably most important, the patient and family should be carefully educated about this complication (name tag). Most deaths from hyposplenia-related septicemia are preventable.
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