Education And Debate

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

BMJ 1996; 312 doi: http://dx.doi.org/10.1136/bmj.312.7028.430 (Published 17 February 1996) Cite this as: BMJ 1996;312:430

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 to mount an adequate protective antibody response may relate more to the indication for or age at splenectomy and to the presence of underlying immune suppression than to the absence of the spleen.

This paper presents the conclusions of an ad hoc working party of the British Committee for Standards in Haematology on procedures for managing patients without a spleen. In accordance with guidance on best practice5 6 the guidelines are based on an assessment of published evidence and the expert opinion of the working party.

Methods

Assessment of published evidence—The CD-ROM databases Silver Platter Medline (1966-95) and Excerpta Medica (1974-95) were searched by using the keywords infection, splenectomy, asplenia, and hyposplenism. Abstracts in English (of English and non-English articles) were reviewed. In addition, bibliographies of previous reviews and papers describing original research were cross checked.

Guideline development group—In view of the potential bias in guideline development …

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