Hyposplenism

Hyposplenism may be:

• Absence of spleen 
• Trauma
• Congenital asplenia 
• Iatrogenic - for example in treatment of Gaucher's disease or autoimmune haemolytic anaemia
• Functional – associated with
• GI causes
• Coeliac disease
• Inflammatory bowel disease 
• Whipples disease 
• Liver cirrhosis 
• Haematological causes
• Sickle cell disease 
• Primary thrombocythaemia 
• Autoimmune 
• SLE 
• Rheumatoid arthritis 
• Graves’ disease
• Other 
• Amyloidosis 
• Sarcoidosis 
• Acute alcoholism

Blood film in hyposplenism may show

• Howell-Jolly bodies 
• Acanthocytes 
• Target cells 

Hyposplenism results in an increased risk of life-threatening infection, particularly by:

• Encapsulated organisms such as 
• Pneumococci 
• Haemophilus influenzae 
• Meningococci 
• Intraerythrocytic parasites 
• Plasmodia falciparum 
• Babesia microti

Management of hyposplenism/asplenism:

• Vaccination
• Pneumococcal vaccine, Hib vaccine and meningococcal B and C vaccines 
• Yearly influenza vaccination
• Lifelong prophylactic antibiotics should be considered with either penicillin or macrolides

Small print gem: after splenectomy, the risk of overwhelming infection is greatest in the first 2 years.

References:

Brigden, M. Detection, education and management of the asplenic or hyposplenic patient. Am Fam Physician. 2001; 63(3): 499-506. 

Davies, J. et al. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: Prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force. British Journal of Haematolofy. 155(3): 308-317. 

Muller, A. and Toghill, P. Hyposplenism in gastrointestinal disease. Gut. 1995; 36(2): 165-167.