Problemi non correnti
Indicazioni alla splenectomia
INDICATIONS TO SPLENECTOMY
PAOLO TAMARO, ELSA BARTH
Clinica Pediatrica, Centro di Emato-Oncologia, IRCCS “Burlo Garofolo”, Trieste
Giugno 2000 - pagg. 373 -375
Abstract
Progress in surgical techniques and in management and understanding of haematologic diseases
stimulate a critical reappraisal of splenectomy. Spleen plays an important role in removing
normal and abnormal cells from the blood and in providing immunologic response
to encapsulated bacteria. Surgical splenectomy provides effective treatment for several
paediatric disorders, such as congenital and acquired haemolytic anemias, abdominal
traumas, immunologic and metabolic disorders, but it is associated with immediate risk of
morbidity and life-long risk of overwhelming infection. Alternatives to conventional splenectomy
include laparoscopic splenectomy, partial splenectomy, partial splenic embolisation
and autologous splenic transplantation. Recommendations for the prevention of overwhelming
postsplenectomy infection include pneumococcal, H. influentiae type b and meningococcal
immunisations, antimicrobial prophylaxis and prompt antibiotic treatment of acute
febrile illness. Asplenic patients should be also advised on the increased risk of severe falciparum
malaria and susceptibility to babesiosis and infection by C. canimorsum. Finally,
prophylaxis for thrombotic risk is recommended in selected cases.
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 1991;78:1031-8.
3. Hosea SW, Brown EJ, Hamburger MI, Frank MM. Opsonic requirements for intravascular clearance after splenectomy. N Engl J Med 1981;5:245-50. 4.Wolf HM, Eibl MM, Georgi E, Samstag A, Spatz M, Uranus S, Passl R. Long-term decrease of CD4+ CD45RA+ T cells and impaired primary immune response after posttraumatic splenectomy. Br J Haem 1999; 107:55-68.
5. Kimber C, Spitz L, Drake D, Kiely E, Westaby S, Cozzi F, Pierro E. Elective partial splenectomy in childhood. J Pediatr Surg 1998;33:826-9.
6. Bernard T, Rhodes M, Turner GE, Wimperis JZ, Deane AM. Laparoscopic splenectomy: single-centre experience of a district general hospital. Br J Haem 1999;106,1065-7.
7. Jandl JH. The spleen and hypersplenism in Blood, 2nd edition. Little, Brown Company, USA, chapt 14 1997:587-588.
8. Working Party Of The British Committee For Standards In Haematology - Clinical Haematology Task Force: guidelines for the prevention and treatment of infection in patient with an absent or dysfunctional spleen. BMJ 1996;312:430-4.
9. Keenan RD, Boswell T, Milligan DW. Do post-splenectomy patients take prophylactic penicillin? Br J Haem 1999;105:509-10.
10. Sandler A, Winkel G, Kimura K, Soper R. The role of prophylactic cholecystectomy during splenectomy in children with hereditary spherocytosis. J Pediatr Surg 1999;34:1077-8.
11. Thalassaemia’s International Federation: Management Protocol For The Treatment Of Thalassaemia Patients, 1997 Ed.
12. Lilleyman JS. Management of childhood idiopathic thrombocytopenic purpura. Br J Haem 1999;105:871-5.