Can partial splenectomy preserve humoral immunity in pediatric patients? Risks and benefits of partial splenectomy
1Division of Pediatric Oncology, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy
2 Department of Pediatric Haemato-Oncology, Ospedale G.Salesi, Ancona, Italy
3 Division of Pediatric Surgery, Catholic University of Rome, A. Gemelli Hospital, Rome, Italy
DOI: 10.22514/SV141.052018.2 Vol.14,Issue 1,March 2018 pp.17-19
Published: 27 March 2018
The spleen plays an important role in re-moving normal and abnormal cells from the blood and in providing an immuno-logic response to encapsulated bacteria. Surgical splenectomy provides effective treatment for several pediatric disorders, such as congenital and acquired hemolytic anemias, abdominal traumas and immu-nological and metabolic disorders, but it is associated with an immediate and life-long risk of overwhelming infection. An alternative to conventional splenectomy is partial splenectomy, recommended espe-cially in children younger than 5 years of age. Recommendations for the prevention of overwhelming post-total splenectomy infection include: Pneumococcal, Haemo-philus influenzae type B and Meningococ-cal immunizations, antimicrobial prophy-laxis and prompt antibiotic treatment of acute febrile illness; conversely, there is no clear evidence indicating which preven-tion measures are to be performed in pa-tients undergoing partial splenectomy.
partial splenectomy, children, immunization
MARTINA CATALANO,DANIELA RIZZO,PAOLA COCCIA,PALMA MAURIZI,LORENZO NANNI,ANTONIO RUGGIERO. Can partial splenectomy preserve humoral immunity in pediatric patients? Risks and benefits of partial splenectomy. Signa Vitae. 2018. 14(1);17-19.
1. Mebius RE, Kraal G. Structure and function of the spleen. Nat Rev Immunol 2005;5:606–16.
2. Buzelé R, Barbier L, Sauvanet A, Fantin B. Medical complications following splenectomy. J Visc Surg 2016;153(4):277-86.
3. Kruetzmann S, Rosado MM, Weber H, Germing U, Tournilhac O, Peter HH, et al. Human immunoglobulin M memory B cells con-trolling Streptococcus pneumoniae infections are generated in the spleen. J Exp Med 2003;197:939–45.
4. Ruggiero A, Rizzo D, Attinà G, Lazzareschi I, Mastrangelo S, Maurizi P, et al. Phase I study of temozolomide combined with oral etoposide in children with recurrent or progressive medulloblastoma. Eur J Cancer 2010;46(16):2943-9.
5. de Porto AP, Lammers AJ, Bennink RJ, ten Berge IJ, Speelman P, Hoekstra JB. Assessment of splenic function. Eur J Clin Microbiol Infect Dis 2010;29:1465–73.
6. Tarantino G, Savastano S, Capone D, Colao A. Spleen: A new role for an old player? World J Gastroenterol 2011;17(33):3776-84.
7. Bickenbach KA, Gonen M, Labow DM, Strong V, Heaney ML, Zelenetz AD, Coit DG. Indications for and efficacy of splenectomy for haematological disorders. Br J Surg 2013;100(6):794-800.
8. Bansal D, Bhamare TA, Trehan A, Ahluwalia J, Varma N, Marwaha RK. Outcome of chronic idiopathic thrombocytopenic purpura in children. Pediatr Blood Cancer 2010;54(3):403-7.
9. Machado NO, Grant CS, Alkindi S, Daar S, Al-Kindy N, Al Lamki Z, Ganguly SS. Splenectomy for haematological disorders: a single center study in 150 patients from Oman. Int J Surg 2009;7(5):476-81.
10. Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma 2002;53:950–6.
11. Dionne B, Dehority W, Brett M, Howdieshell TR. The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination. Surg Infect (Larchmt). 2017 Jul;18(5):536-44. doi: 10.1089/sur.2016.267. Epub 2017 May 12.
12. Chong J, Jones P, Spelman D, Leder K, Cheng AC. Overwhelming post-splenectomy sepsis in patients with asplenia and hyposplenia: a retrospective cohort study. Epidemiol Infect 2017;145(2):397-400.
13. Salvadori MI, Price VE; Canadian Paediatric Society, Infectious Diseases and immunization Committee.. Preventing and treating infections in children with asplenia or hyposplenia. Paediatr Child Health 2014;19(5):271-8.
14. Eber S, Lux SE. Hereditary spherocytosis--defects in proteins that connect the membrane skeleton to the lipid bilayer. Semin Hematol 2004;41(2):118-41.
15. Upadhyaya P. Conservative management of splenic trauma: history and current trends. Pediatr Surg Int 2003;19:617–27.
16. Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg 1991;78:716–21.
17. Sheikha AK, Salih ZT, Kasnazan KH, Khoshnaw MK, Al-Maliki T, Al-Azraqi TA, Zafer MH. Prevention of overwhelming postsple-nectomy infection in thalassemia patients by partial rather than total splenectomy. Can J Surg 2007;50(5):382-6.
18. Idowu O, Hayes-Jordan A. Partial splenectomy in children under 4 years of age with hemoglobinopathy. J Pediatr Surg 1998;33(8):1251-3.
19. Van Wyck DB, Witte MH, Witte CL. Compensatory spleen growth and protective function in rats. Clin Sci (Lond) 1986;71(5):573-9.
20. Ruggiero A, De Rosa G, Rizzo D, Leo A, Maurizi P, De Nisco A, et al. Myocardial performance index and biochemical mark-ers for early detection of doxorubicin-induced cardiotoxicity in children with acute lymphoblastic leukaemia. Int J Clin Oncol 2013;18(5):927-33.
21. Wolf HM, Eibl MM, Georgi E, Samstag A, Spatz M, Uranüs S, et al. Long-term decrease of CD4 CD45RA T cells and impaired pri-mary immune response after post-traumatic splenectomy. Br J Haematol 1999;107:55–68.
22. Bader-Meunier B, Gauthier F, Archambaud F, Cynober T, Miélot F, Dommergues JP, et al. Long-term evaluation of the beneficial ef-fect of subtotal splenectomy for management of hereditary spherocytosis. Blood 2001;97(2):399-403.
23. Rice HE, Oldham KT, Hillery CA, Skinner MA, O'Hara SM, Ware RE. Clinical and hematologic benefits of partial splenectomy for congenital hemolytic anemias in children. Ann Surg 2003;237(2):281-8.
24. Buesing KL, Tracy ET, Kiernan C, Pastor AC, Cassidy LD, Scott JP, et al. Partial splenectomy for hereditary spherocytosis: a multi-institutional review. J Pediatr Surg 2011;46(1):178-83.
25. Schilling RF. Risks and benefits of splenectomy versus no splenectomy for hereditary spherocytosis--a personal view. Br J Haematol 2009;145(6):728-32.
26. Marques RG, Petroianu A, Coelho JM, Portela MC. Regeneration of splenic autotransplants. Ann Hematol 2002;81(11):622-6.
27. Morinis J, Dutta S, Blanchette V, Butchart S, Langer JC. Laparoscopic partial vs total splenectomy in children with hereditary sphero-cytosis. Pediatr Surg 2008;43(9):1649-52.
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