AML = acute myeloid leukemia, COPD = chronic obstructive pulmonary disease, GN = glomerulonephritis, MDS = myelodysplastic syndrome, MOF = multiple organ failure, OPSI = overwhelming post splenectomy infection, PBSCTx = peripheral blood stem cell transplantation, UIP = usual interstitial pneumonitis, VAHS = virus-associated hemohagocytotic syndrome, VZV = varizella zoster virus.
Moreover, we must be careful for overwhelming post-splenectomy infection.
Currently, splenopexy becomes a favorable alternative especially in pediatric patients, without involving splenic infarction or venous thrombosis, to avoid the risk of overwhelming post-splenectomy sepsis [3].
After splenectomy, patients are at increased risk of overwhelming post-splenectomy infection (OPSI; see Table 2 [ 1– 4].
Hyposplenic patients are at risk of overwhelming post-splenectomy infection (OPSI), which carries mortality of up to 70%.
For those who develop fulminant, overwhelming post-splenectomy sepsis, mortality rates approach 50% [ 7], and those who survive may be left with significant morbidity.
Secondary endpoints were overall morbidity, overwhelming post-splenectomy infection (OPSI /quality of life, blood transfusion, abdominal abscesses and length of hospital stay.
The most serious complication is overwhelming post-splenectomy infection, although its frequency has dropped due to aggressive pneumococcal vaccination, prophylactic penicillin, and prompt administration of parenteral antibiotics when fever occurs [ 24– 26].
Moreover, data on the remaining analyzed outcomes (hospital stay, number of blood transfusions, abdominal abscesses, overwhelming post-splenectomy infection) were not reported in all included studies or were not comparable, precluding the possibility to perform a meaningful cumulative analysis and comparison.
An ideal system to ensure compliance with guidelines has not been reported, but a post-splenectomy registry may provide a systematic approach to this population, and could be cost-effective in terms of avoidance of mortality and overwhelming post-splenectomy sepsis [ 33].
The most critical action in the management of overwhelming post-splenectomy infection is vigilance against Streptococcus pneumoniae and the immediate use of broad-spectrum intravenous antibiotics, ideally based on the result of blood cultures [17].
