May 13, 2011 by dailybolusoflr
Asplenic Patients in the ED
Patients who are anatomically or functionally asplenic are at higher risk for the development of infection as well as the progression to significant overwhelming sepsis related to that infection.
The most common organisms leading to asplenic sepsis are encapsulated organisms
· Streptococcus pneumonia (the most common)
· Haemophilus influenza
· Neisseria meningitides
· The highest incidence of fulminant sepsis is in children and in lymphoma patients who have had surgical resection of their spleen in conjunction with treatment.
· Post-splenectomy sepsis can develop rapidly after a seemingly minor infection. Many patients will have oral antibiotics (such as augmentin) at home and are instructed to take a first dose of antibiotics at the first sign of any infection before leaving for the nearest ED/clinic.
· Patients may present rapidly after onset with acute distress, intractable rigors, high fever, hypotension and have complications of bacteremia that can include petechiae, purpura, meningitis, or gangrene.
· As soon as patients with asplenia present to the ED with s/sx of systemic infection, they should be promptly treated with broad spectrum antibiotics that cover the common encapsulated organisms. Typical treatment includes vancomycin and ceftriaxone IV. The recommendation is NOT to wait as the evaluation is performed in these patients but to treat as soon as they present.
· Patients with contraindications to cephalosporins can be treated with high dose levofloxacin 750mg IV.
Am Fam Physician. 2001 Feb 1;63(3):499-508.
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions