• Indication for PLEX?
  • Microangiopathic hemolytic anemia and thrombocytopenia, with or without renal failure or neurologic abnormalities, and without another apparent cause for thrombotic microangiopathy
  • Must send ADAMTS13 prior to initiation of PLEX
  
  

  Posted 09/14/16 09:17:41 AM by Matthew Cummings

• Immunity in the Asplenic Patient
  • Red pulp: removes aged/defective RBCs
  • White pulp: Humoral and cell-mediated immune response
  • Phagocytes ingest circulating bacteria (unopsonized)
    • Opsonization of Ig and complement-coated bacteria 
    • Encapsulated organisms – thrive in absence of phagocytosis, opsonization mediated by splenic MØ (S. pneumoniae (85%) >> H. influenza, N. meningitidis, Babesia sp.)
  
  

  Posted 09/14/16 09:42:37 AM by Matthew Cummings

• Sepsis in the Asplenic Patient
  • Highest risk in 1st year post-splenectomy
  • Short, non-specific prodromal phase, +/- fever
  • Often no obvious primary infectious source
  • Severe clinical course due to overwhelming bacteremia
    • Shock, DIC, multi-organ failure
    • Waterhouse-Fredrichsen syndrome
      •Lancet 1911, “Hemorrhagic adrenalitis” à unilateral or bilateral adrenal hemorrhage
      •Classically but not exclusively associated with N. meningitidis
  
  
  
  

  Posted 09/14/16 09:43:34 AM by Matthew Cummings

• Capnocytophaga canimorsus
  • Encapsulated, intra-cellular GNR
    • Found in saliva of healthy dogs/cats, humans à bites
  • Severe infection more common post-splenectomy, ETOH abuse
    • Septic shock
    • Meningitis, endopathalmitis
    • Endocarditis, sustained bacteremia
    • Digital gangrene, purpura fulminans
  • PCN or 3rd generation cephalosporin are drugs of choice
  
  

  Posted 09/14/16 09:45:02 AM by Matthew Cummings

• For further reading...

  Indications for plasma exchange (Am. Soc. Hematology Review)
  Overwhelming post-splenectomy infection (Review)
  Capnocytophaga: emerging cause of sepsis
  Care of the asplenic patient (NEJM review)
  Capnocytophaga NEJM CPC
  
  

  Posted 09/14/16 09:48:22 AM by Matthew Cummings

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