๐Ÿฉธ Chapter 536 ยท Hyposplenism, Splenic Trauma, and Splenectomy

Nelson Textbook of Pediatrics 22nd Edition | Hyposplenism/functional asplenia: sickle cell disease (by age 5 years), celiac disease, inflammatory bowel disease, congenital asplenia (Ivemark syndrome). Labs: Howell-Jolly bodies, pits on RBCs. Overwhelming post-splenectomy infection (OPSI): encapsulated bacteria (S. pneumoniae, H. influenzae type b, N. meningitidis). Prevention: vaccinations (PCV13, PPSV23, MenACWY, MenB, Hib) + prophylactic penicillin. Splenic trauma: non-operative management (NOM) in 80-90% of children. Splenectomy indications: severe trauma, refractory immune cytopenias, hereditary spherocytosis (severe), hypersplenism.

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๐Ÿ“‹ 30 Clinical Scenarios โ€” Hyposplenism, Splenic Trauma, Splenectomy

๐Ÿ“‡ Highโ€‘Yield Review Cards (Hyposplenism & Splenectomy)

๐Ÿฉบ Clinical Recognition: Hyposplenism & Splenic Trauma

Select a presentation for diagnostic clues and management.

๐Ÿ“‹ Stepwise Management of Hyposplenism, Splenic Trauma, Splenectomy

๐Ÿ”‘ Key Principles โ€” Nelson Chapter 536
โ€ข Hyposplenism (functional asplenia): Sickle cell disease (by age 5 years), celiac disease, inflammatory bowel disease, congenital asplenia. Labs: Howell-Jolly bodies, pits on RBCs.
โ€ข Overwhelming post-splenectomy infection (OPSI): Encapsulated bacteria (S. pneumoniae (60%), H. influenzae, N. meningitidis). Prevention: Vaccinations (PCV13, PPSV23, MenACWY, MenB, Hib) + prophylactic penicillin (125-250 mg BID).
โ€ข Splenic trauma: Non-operative management (NOM) in 80-90% (hemodynamically stable, grade I-III). ICU monitoring, blood transfusion if needed.
โ€ข Splenectomy indications: Severe trauma (unstable, grade IV-V), hereditary spherocytosis (severe), ITP (refractory, >6 years), thalassemia (hypersplenism), Gaucher disease.
โ€ข Post-splenectomy complications: OPSI, thrombosis (platelet count โ†‘), pulmonary hypertension.

    โšก Reflex Prompts โ€” Clinical Decisions in Hyposplenism/Splenectomy

    ๐Ÿ“– Summary: Hyposplenism, Splenic Trauma, Splenectomy โ€” Nelson Ch 536