Acronym for Overwhelming Post-Splenectomy Infection

Severe infection occurring in splenectomized patients and resulting in death in more than 50 % of cases. It occurs in 5 % of children and 0.9 % of splenectomized adults.

The main causes are of anatomical or functional splenectomy are:

• asplenia (Ivermark, APECED and Stromoken syndrome) or hyposplenia (following repeated splenic infarcts (sickle cell disease, beta-thalassemia) or a systemic overload disease (Gaucher disease, etc.)
• surgical or post-radiotherapy splenectomy

Recommendations:

• scheduled splenectomy:

1. check the patient's vaccination status against encapsulated bacteria: Hemophilus influenzae B, pneumococcus, meningococcus (A, B, C, Y, W)
2. if the patient is not vaccinated: vaccinate him/her (first injection) if possible > 2 weeks before the procedure

• emergency splenectomy: vaccinate ideally > 2 weeks after the procedure
• in all cases: annual vaccination against flu

Anesthetic implications:

in splenectomized patients or before splenectomy: strict asepsis, check vaccination status, antibioprophylaxis

References : 

-         Haut Conseil de la Santé Publique : Vaccinations des personnes immunodéprimées ou aspléniques : rapport de recommandations du haut conseil de la santé publique (France) (2014)

Update: February 2023