What advice should be given to a patient who has undergone splenectomy because of trauma? What guidelines do you recommend for both medical and dental follow-up?—JAMES TANNER, PA-C, Spring Hill, Tenn.
Postsplenectomy patients are at risk for hemolytic anemia and thrombocytopenia. The greatest risk for these patients is overwhelming bacterial infection, which can be fatal. Younger patients and those with recent splenectomy merit extra attention. Patients are most susceptible to capsulated bacteria. Pneumococcus is the most common pathogen, followed by Hemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, and others. Patients should receive all appropriate immunizations. Use of prophylactic antibiotics is controversial because of a lack of definitive data, rise in resistance, and problems with compliance. Recommendations should be made on an individual basis. Educate patients on the signs and symptoms of sepsis and the need for prompt access to care.—Claire Babcock O'Connell, MPH, PA-C (133-4)