Hyposplenic patients need prophylactic penicillin

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6921.132c (Published 08 January 1994) Cite this as: BMJ 1994;308:132
  1. A F Muller,
  2. P J Toghill
  1. City Hospital, Nottingham NG5 1PB University Hospital, Queen's Medical Centre, Nottingham NG7 2UH.

    EDITOR,- We welcome the articles highlighting the risk of serious infection in patients who have had a splenectomy,*RF 1-3* but this may be only part of the problem: old age and several disparate diseases are associated with hyposplenism in people with an intact spleen. Functional hyposplenism of this kind also renders patients vulnerable to fulminant sepsis.

    For patients with sickle cell disease or thrombocythaemia who have infarction of splenic tissue and patients with infiltrative disease of the spleen the mechanism is easy to understand. In gastrointestinal diseases such as inflammatory bowel, coeliac, and alcoholic liver disease, however, the reason for the hyposplenism is obscure. Overwhelming pneumococcal disease has been recorded in all of these conditions in association with hyposplensim.4 5 Overwhelming sepsis and disseminated intravascular coagulation have also been reported in hyosplenic patients with ulcerative colitis in the immediate period after colectomy.

    There is evidence that prophylactic penicillin is effective in children with sickle cell disease, and it seems sensible to give similar prophylaxis to hyposplenic patients with other diseases. Identifying such patients is now relatively easy with the method of counting pitted red cells under differential interference contrast microscopy. The risks of fulminant sepsis in patients who may be hyposplenic must be borne in mind, and such patients should be treated promptly with antibiotics when they become febrile.

    At present there is insufficient evidence to justify giving pneumococcal vaccine to all patients who may be hyposplenic. Nevertheless, it seems prudent to vaccinate certain high risk groups such as children with sickle cell disease and patients with severe extensive chronic inflammatory bowel disease.


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