Detection, education and management of the asplenic or hyposplenic patient

Fulminant, potentially life-threatening infection is a major long-term risk after splenectomy or in persons who are functionally hyposplenic as a resu lt of various systemic conditions. Most of these infections are caused by e ncapsulated organisms such as pneumococci, Haemophilus influenzae and menin gococci. A splenectomized patient is also more susceptible to infections wi th intraerythrocytic organisms such as Babesia microti and those that seldo m affect healthy people, such as Capnocytophaga canimorsus. Most patients w ho have lost their spleens because of trauma are aware of their asplenic co ndition, but some older patients do not know that they are asplenic. Other patients may have functional hyposplenism secondary to a variety of systemi c diseases ranging from celiac: disease to hemoglobinopathies. The identifi cation of Howell-Jolly bodies on peripheral blood film is an important clue to the diagnosis of asplenia or hyposplenia. Management of patients with t hese conditions includes a combination of immunization, antibiotic: prophyl axis and patient education. With the increasing prevalence of antibiotic-re sistant pneumococci, appropriate use of the pneumococcal vaccine has become especially important.