Northern Region asplenia register - analysis of first two years

Objectives-To assess the feasibility of setting up a register of patients w ith asplenia within a defined geographical area; to ensure that guidelines on best practice were implemented; to obtain information on antibody levels to pneumococcal capsular polysaccharides and Haemophilus influenzae type b capsular polysaccharide, before and after immunisation and annually therea fter; to raise awareness of risks among clinicians and to offer advice on m anagement. Design-Prospective recruitment using multiple sources of recruitment. Annua l follow up reminders sent from Registration Centre. Subjects-Population of (old, pre-1995) Northern Health Region: approximatel y 3.1 million. Main outcome measures-Data were obtained on reasons for asplenia, duration of asplenia, use of prophylactic antibiotics, Medic-Alert bracelets, immuni sations, antibody levels, death. Results-The register was initiated at the beginning of April 1995 and ran t o the end of March 1997. After two years of operation, 1111 cases had been registered but the response from some health districts was poor. Major prim ary causes of asplenia were trauma (264), other surgical (198), lymphoproli ferative disease (154), and idiopathic thrombocytopenic purpura (147). Ther e were 664 patients on prophylactic antibiotics, of whom 498 were on contin uous antibiotics. Only 18 had any type of warning bracelet. Antibody measur ements were carried out at least once on 75% of patients; 306 patients had satisfactory antibody levels on first blood sample in year 1, rising to 405 in year 2; 43 patients failed to make any antibody response to Pneumovax d espite multiple immunisations, and three patients failed to respond to Hib vaccine. Sixteen patients with satisfactory antibody levels in year 1 had l ow levels in year 2 requiring vaccine boosters. Sixteen deaths were reporte d, two of which were directly attributable to overwhelming sepsis. Conclusions-Registration has been successful and has raised awareness of th e management of asplenia. Compliance with antibiotic prophylaxis and immuni sation was initially poor. A potential high risk group of vaccine non-respo nders has been identified and poor persistence of pneumococcal antibodies h as been identifled which is likely to alter approaches to immunisation in a splenic patients.