WikEM - User contributions [en]

Asplenic patient

2016-09-05T00:51:39Z

Jwcombs:

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
**Splenic rupture/hemorrhage
*Functional
**[[Sickle cell disease]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

[[File:Asplenia.jpg|thumb|CT of an asplenic patient]]

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

[[file:Splenectomyblood - Edited.jpg|thumb|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells.]]

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults<ref name=Uptodate>Pasternick, Mark S et al. Prevention of sepsis in the asplenic patient. Uptodate. 2016.</ref>

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals<ref name=NEJMcare>Lorry G. Rubin, M.D., and William Schaffner, M.D.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291</ref>

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)
*Consider admitting asplenic patients presenting with fever

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

User:Jwcombs

2016-09-03T02:48:14Z

Jwcombs:

MS4, UC Irvine School of Medicine

User:Jwcombs

2016-09-03T02:47:43Z

Jwcombs:

MS4, US-CA.
UC Irvine School of Medicine

Asplenic patient

2016-09-03T02:46:35Z

Jwcombs:

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC [[file:Splenectomyblood - Edited.jpg|thumb|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells. <ref name=Propath>Litz, Craig E. The Post Splenectomy Blood Picture. Propath. Feb 2012. https://www.propath.com/companies/press-clippings/26-newsletters/316-the-post-splenectomy-blood-picture-february-2012</ref>]]
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults<ref name=Uptodate>Pasternick, Mark S et al. Prevention of sepsis in the asplenic patient. Uptodate. 2016.</ref>

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals<ref name=NEJMcare>Lorry G. Rubin, M.D., and William Schaffner, M.D.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291</ref>

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-09-03T02:44:34Z

Jwcombs: /* Workup */

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC [[file:Splenectomyblood - Edited.jpg|thumb|Post-splenectomy blood smear demonstrating Howell-Jolly bodies and target cells. <ref name=Propath>Litz, Craig E. The Post Splenectomy Blood Picture. Propath. Feb 2012. https://www.propath.com/companies/press-clippings/26-newsletters/316-the-post-splenectomy-blood-picture-february-2012</ref>]]
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults<ref name=Uptodate>Pasternick, Mark S et al. Prevention of sepsis in the asplenic patient. Uptodate. 2016.</ref>

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals<ref name=NEJMcare>Lorry G. Rubin, M.D., and William Schaffner, M.D.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291</ref>

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

File:Splenectomyblood - Edited.jpg

2016-09-03T02:41:09Z

Jwcombs: Peripheral blood smear after splenectomy.

Peripheral blood smear after splenectomy.

Asplenic patient

2016-09-03T02:36:50Z

Jwcombs: /* Vaccination management */

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults<ref name=Uptodate>Pasternick, Mark S et al. Prevention of sepsis in the asplenic patient. Uptodate. 2016.</ref>

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals<ref name=NEJMcare>Lorry G. Rubin, M.D., and William Schaffner, M.D.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291</ref>

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-09-03T02:34:22Z

Jwcombs: /* Prophylaxis */

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals<ref name=NEJMcare>Lorry G. Rubin, M.D., and William Schaffner, M.D.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291</ref>

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-09-03T02:32:05Z

Jwcombs: /* Sepsis */

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection
*overwhelming majority of cases are from [[streptococcus]]

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-09-03T02:29:07Z

Jwcombs:

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

[[File:Asplenia.jpg|thumb|CT of an asplenic patient<ref name=picture>Dr. Owen Kang and A.Prof Frank Gaillard, et al. Autosplenectomy. Radiopedia. http://radiopaedia.org/articles/autosplenectomy</ref>]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-09-03T02:22:49Z

Jwcombs: /* Presentation */

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation=== [[File:Asplenia.jpg|thumb|CT of an asplenic patient]]
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

File:Asplenia.jpg

2016-09-03T02:21:10Z

Jwcombs: CT scan of an asplenic patient.

CT scan of an asplenic patient.

Asplenic patient

2016-09-03T02:01:28Z

Jwcombs:

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**[[Sickle cell disease]]
**[[Immune thrombocytopenic purpura]]
**[[Hodgkin's lymphoma]]
**[[Thalassemia]]
**[[Hereditary spherocytosis]]
*Functional
**[[Sickle cell disease]]

===Asplenia increases risk of (and worsens course of)===
*[[Pneumonia]]
*[[Sepsis]]/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**[[cough]]
**[[fever]]
**increasing oxygen requirement
**malaise
**[[rash]]
**[[nausea/vomiting]]
**[[constipation]]/[[diarrhea]]
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection ([[sepsis]])
**[[Streptococcus]] pneumonia
**[[Haemophilus influenzae]] type B
**[[Neisseria meningitidis]]
**[[Capnocytophaga canimorsus]]
**[[Bordetella holmesii]]
*Viral illness

==Evaluation==
===Workup===
*CBC
*BMP
*CXR
*Blood cultures x2
*UA w/ culture
*Wound culture, if present
*Peripheral blood smear
**Howell Jolly bodies
**Heinz Bodies
**Pappenheimer bodies
**Target cells
**Increased WBCs
**Increased platelets

==Management==
===[[Sepsis]]===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection

===[[Fever]] (no sepsis)===
*treat empirically with broad spectrum antibiotics
**[[amoxicillin-clavulanate]]: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**[[cefuroxime]]: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**[[levofloxacin]] 750 mg once daily (adults or adolescents only)
**[[moxifloxacin]] 400 mg once daily (adults or adolescents only)
**[[gemifloxacin]] 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily [[Penicillin VK]] or [[amoxicillin]]
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals

==Disposition==
*Based on presenting complaint/illness (asplenia by itself is not an indication for admission)

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
<references/>

Asplenic patient

2016-08-31T03:48:30Z

Jwcombs: Created page with "==Background== ===Causes of asplenia=== *Congenital *Surgical **Previous hypersplenism **Sickle cell disease **Immune thrombocytopenic purpura **Hodgkin's Lymphoma **Thalassem..."

==Background==
===Causes of asplenia===
*Congenital
*Surgical
**Previous hypersplenism
**Sickle cell disease
**Immune thrombocytopenic purpura
**Hodgkin's Lymphoma
**Thalassemia
**Hereditary spherocytosis
*Functional
**Sickle cell disease

===Asplenia increases risk of (and worsens course of)===
*Pneumonia
*Sepsis/septicemia
*Infections from encapsulated bacteria
*Viral diseases

==Clinical Features==
===CBC & Blood smear===
*Howell Jolly bodies
*Heinz Bodies
*Pappenheimer bodies
*Target cells
*Increased WBCs
*Increased platelets

===Presentation===
*Sickle-cell disease patient over the age of 8
*absent spleen on CT
*otherwise asplenic patient

===If Septic===
*Nonspecific symptoms
**cough
**fever
**increasing oxygen requirement
**malaise
**rash
**nausea/vomiting
**constipation/diarrhea
**urinary symptoms
**rigors
*wound infection (perhaps from dog bite)

==Differential Diagnosis==
*Bacterial infection (sepsis)
**Streptococcus pneumonia
**Haemophilus influenzae type B
**Neisseria meningitidis
**Capnocytophaga canimorsus
*Viral illness

==Workup==
*blood smear
*CBC
*BMP
*CXR
*x2 blood cultures
*UA w/ culture
*wound infection cultures
*additional imaging as necessary

==Management==
===Sepsis===
*30mL/kg fluids
*broad spectrum antibiotics appropriate for suspected infection

===Fever (no sepsis)===
*treat empirically with broad spectrum antibiotics
**amoxicillin-clavulanate: 90mg/kg amox per day in children divided into two doses; 875 mg/125 bid for adults
**cefuroxime: 30mg/kg per day in children divided into two doses; 500mg bid for adults
**levofloxacin 750 mg once daily (adults or adolescents only)
**moxifloxacin 400 mg once daily (adults or adolescents only)
**gemifloxacin 320 mg once daily (adults or adolescents only)

===Vaccination management===
*4 doses of PCV13 before 15 months
*PPSV23 at least 8 weeks after last PCV13, first at age 2
*2nd dose of PPSV23 3 years after first
**(if patient is >6years and has not received PCV13 or PPSV23, dose 1 time with PCV13 then dose with PPSV23 8 weeks later)
**(if patient is >6years but <18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 8 weeks after last PPSV23)
**(if patient is >18 years and has not received PCV13 but has received PPSV23, dose 1 time with PCV13 at least 1 year after last PPSV23)
*Redose PPSV23 every 5 years
*Hib conjugate vaccine for all unvaccinated patients above the age of 5 years
*inactivated influenza vaccine yearly
*Neisseria meningitidis vaccine for asplenic adults

===Prophylaxis===
*Daily Penicillin VK or amoxicillin
*for children up to age of 5 or for 1 year following splenectomy
*potentially up to age of 18 for highly immunocompromised individuals

==Disposition==
*to appropriate level of care for presenting illness
*asplenia not an indication for admission

==See Also==
*[[Vaccination schedule]]
*[[Sepsis]]

==External Links==

==References==
Lorry G. Rubin, M.D., and William Schaffner, M.D. Care of the Asplenic Patient.
N Engl J Med 2014; 371:349-356July 24, 2014DOI: 10.1056/NEJMcp1314291.

http://www.nejm.org/doi/full/10.1056/NEJMcp1314291
<references/>