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Asplenia
What is Asplenia?
Asplenia refers to the absence ('a-') of normal spleen function and is associated with some serious infection risks.
Hyposplenism is used to describe reduced ('hypo-') splenic functioning, but not as severely affected as with asplenism.
Signs & Symptoms
Management
To minimise the risks, antibiotic & vaccination protocols have been established, but are often poorly adhered to by doctors and patients.
Antibiotic prophylaxis
Because of the increased risk of infection, physicians administer oral antibiotics as a prophylaxis after a surgical splenectomy. The duration suggested varies: one suggestion is that antibiotics be taken for two years or until the age of sixteen years old is reached, whichever is longer.
Patients are also cautioned to start a full-dose course of antibiotics at the first onset of an upper or lower respiratory tract infection (for example, sore throat or cough), or at the onset of any fever.
Vaccinations
It is suggested that splenectomized persons receive the following vaccinations, and ideally prior to planned splenectomy surgery:
• pneumococcus every 6 years (a conjugated form is used for children under 2 years)
• Haemophilus influenzae - whilst in many countries now routinely given to all children, a single booster is advised following the development of asplenia, but for those adults who have not been previously vaccinated, two doses given two months apart were advised in the new 2006 UK vaccination guidelines (in the UK may be given as a combined Hib/MenC vaccine).
• meningococcus-'C' conjugate vaccine - again routinely given to children in many countries, previously vaccinated adults require a single booster and non-immunised adults advised, in UK since 2006, to have two doses given two months apart.
• annual flu vaccinations - to help prevent getting secondary bacterial infection.
Travel measures
In addition to the normal immunisations advised for the countries to be visited, Group A meningococcus should be included if visiting counties of particular risk (e.g. sub-saharan Africa). The non-conjugated Meningitis A&C vaccines usually used for this purpose give only 3 years coverage and provide less-effective long-term cover for Meningitis C than the conjugated form already mentioned.
Those lacking a functional spleen are at higher risk of catching malaria and dying from this. Travel to malarial areas will carry greater risks and may be best avoided. Travellers should take the most appropriate anti-malarial prophylaxis medication and be extra vigilant over measures to prevent mosquito bites.
The pneumococcal vaccinations may not cover some of the other strains of pneumococcal bacteria present in other countries. Likewise their antibiotic resistance may also vary, requiring a different choice of stand-by antibiotic.
Additional measures
• Surgical and Dental procedures - Antibiotic prophylaxis may be required before certain surgical or dental procedures.
• Animal bites - adequate antibiotic cover is required after even minor dog or other animal bites. Asplenic patients are particularly susceptible to infection by C. canimorsus and should receive a five day course of co-amoxiclav (erythromycin in patients allergic to penicillin).
• Tick bites - Babesiosis is a rare tickborne infection. Patients should check themselves or have themselves inspected for tick bites if they are in an at-risk situation. Presentation with fever, fatigue, and haemolytic anaemia requires diagnostic confirmation by identifying the parasites within red blood cells on blood film and by specific serology. Quinine (with or without clindamycin) is usually an effective treatment.
• Alert warning - Consider carrying a card, or wearing a special bracelet or necklet which says that you do not have a working spleen. This would alert a doctor to take rapid action if you are seriously ill and cannot tell them yourself.
Vitamin & Nutrient Associations
All dietary suggestions when you are dealing with a condition like Asplenia need to be reviewed by your supervising doctors before you implement them.
Working in association with your doctors you may find that nutrition supplementation can be beneficial to keeping your overall wellness high.
Natural Remedies to Cleanse the Spleen
Either juice or blend a steamed selection of the vegetables, herbs and spices together to create a potage soup. Similarly blend fruits with herbs, nutmeg and cinnamon to create 'smoothies'. Take at least one ingredient from each category below to consume daily. Make sure you choose all colours of vegetables and fruits to consume per day: red, green, white, yellow/orange, blue/black/purple. Nature has kindly colour coded natural foods for us and each contain different types of phytonutrients so ay least one of each must be consumed.
Herbs and spices can be taken as teas by pouring hot but not boiling water over a handful of leaves or seeds (or a combination of both) and leaving to steep for 30 minutes then straining and sipping slowly. Can be reheated gently and add honey to sweeten if desired. 3 cups of these teas are recommended per day.
Drink plenty of bottled or filtered water to avoid the impurities and chorine and fluoride chemicals added to tap water. Bottled water can add vital minerals to the diet so is a wise choice.
