Approach to preventing infection in patients with asplenia or hyposplenism

Patients with asplenia or hyposplenism (impaired splenic function) are at higher risk of fulminant sepsis than the general population. The most common pathogen associated with sepsis in these patients is Streptococcus pneumoniaeDi Sabatino 2011Rubin 2014Theilacker 2016. Other encapsulated bacteria (eg Haemophilus influenzae type b (Hib), Neisseria meningitidis), nonencapsulated bacteria (including those acquired from animal bites) and parasites (eg malaria) may also cause sepsisDavies 2011.

Measures to prevent infection in patients with asplenia or hyposplenism are education, immunisation and antibiotic prophylaxisKanhutu 2017.

Education includes advice about the risk of sepsis, infection risks associated with travel and animal bites, and the provision of a fever action plan – see also Self-management of fever in patients with asplenia or hyposplenism. Spleen Australia provides patient education material, as well as information about the management of patients with asplenia or hyposplenism.

In patients with asplenia or hyposplenism, vaccinations are recommended for pneumococcal, meningococcal, Haemophilus influenzae type b (Hib) and influenza. For patients undergoing elective splenectomy, if possible, start vaccination at least 1 to 2 weeks before surgery. For patients who have undergone an emergency splenectomy, start vaccination at least 7 days after surgery. For more detailed information, see the Australian Immunisation Handbook and Spleen Australia.