Details

Autor(en) / Beteiligte

• Ladhani, Shamez N.
• Fernandes, Savio
• Garg, Mamta
• Borrow, Ray
• Lusignan, Simon
• Bolton‐Maggs, Paula H. B.

Titel

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Ist Teil von

• British journal of haematology, 2024-05, Vol.204 (5), p.1672-1686

Ort / Verlag

England: Blackwell Publishing Ltd

Erscheinungsjahr

2024

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Summary Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non‐infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti‐microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks. Identification of patients at risk of serious infection is essential, and this may be at any age dependent on the underlying cause of the reduced or absent splenic function. Patients and their healthcare providers also need full education about the risks. It is likely that there are still many unidentified people at risk. The primary care provider should oversee the responsibility, and patients should receive appropriate immunisations in addition to antibiotic prophylaxis.