Pearls from Dr. Jay Dobkin
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
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