Education and debate

Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen

Correspondence to: Dr I Cavill, Honorary Secretary, British Committee for Standards in Haematology, 2 Carlton House Terrace, London SW 1 Y 5AF.

Working Party of the British Committee for Standards in Haematology Clinical Haematology Task Force

Overwhelming postsplenectomy infection should be preventable if simple precautions are taken. An ad hoc working party of the British Committee for Standards in Haematology has reviewed recommendations for patients without a spleen and drawn up a consensus. Members of the working party were selected for their personal expertise and to represent relevant professional bodies. The guidelines, which are set out below, include and extend the chief medical officer's 1994 update.

Fulminant, potentially life threatening infection is a major long term risk after splenectomy.^{1 2} Splenic macrophages have an important filtering and phagocytic role in removing bacteria and parasitised red blood cells from the circulation.³ Though the liver can perform this function in the absence of a spleen, higher levels of specific antibody⁴ and an intact complement system are probably required. The ability of an asplenic patient . . . [Full text of this article]

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Updated guideline

J M Davies
bmj.com, 2 Jun 2001 [Full text]