Prophylaxis for Post-Splenectomy Infection in Children with Hematologic Disorders

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  • Shichino Hiroyuki
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Okuma Hirotsugu
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Nishikawa Eri
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Shimozawa Katsuyoshi
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Hirai Maiko
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Kato Maiko
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Yagasaki Hiroshi
    Department of Pediatrics and Child Health, Nihon University School of Medicine
  • Chin Motoaki
    Department of Pediatrics and Child Health, Nihon University School of Medicine

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Other Title
  • 小児血液疾患患児に対する脾摘出後の感染症予防についての後方視的検討
  • ショウニ ケツエキ シッカンカンジ ニ タイスル ヒテキシュツ ゴ ノ カンセンショウ ヨボウ ニ ツイテ ノ コウホウ シテキ ケントウ
  • A Retrospective Analysis in a Single Institute

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Abstract

Preoperative pneumococcal vaccination and postoperative antibacterial medication are recommended to prevent serious infection after splenectomy (overwhelming post-splenectomy infection: OPSI). We retrospectively analyzed the prophylactic procedures for OPSI in 12 pediatric patients that recently underwent splenectomy at our hospital. This was an integrated case study. Patients underwent splenectomy between 1999 and 2011, and included 4 males and 8 females, with 7 cases of hereditary spherocytosis and 5 cases of chronic immune thrombocytopenic purpura. The ages at the time of splenectomy were 4 to 21 years old (median: 8 years old), and the follow-up times were from 2 years 4 months to 14 years 4 months. All patients underwent preoperative treatment with 23-Valent pneumococcal vaccine, and two patients received preoperative influenza type b vaccine. None of the patients received Meningococcal vaccine or 7-Valent pneumococcal vaccines. Prophylactic penicillin G (PCG) was administered in all cases after the splenectomy. Doctors stopped administration of PCG to 3 patients within one month. Four patients stopped PCG administration between 4 years 3 months and 9 years 1 month based upon their self-judgment. Only five patients continue to take prophylactic antibacterial medicines from 2 years 4 months to 11 years 1 month (median: 5 years). Six patients ceased to attend the outpatient clinic. While OPSI has not been experienced, OPSI-like severe infection was observed in one patient. The importance of the education of patients and their families regarding the rapid treatment with antibiotics whenever they had fever and the necessity for regular follow-up was recognized.

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