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
- 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...
Posted 09/14/16 09:48:22 AM by Matthew Cummings
Created by Christopher Kelly
Know a hypochondriac? Get them the best-selling book 'AM I DYING?!: A Complete Guide to Your Symptoms, and What to Do Next'
The information on the website does not constitute official guidelines except where explicitly stated.
It is not meant to replace the advice of a health professional.