Hyposplenism: Comparison of different methods for determining splenic function

Lammers, A.J.J.; Porto, Alexander P. N. A. de; Bennink, Roelof J.; Leeuwen, Ester M. M. van; Biemond, Bart J.; Goslings, J. Carel; Marle, J. van; Berge, Ineke J. M. ten; Speelman, Peter; Hoekstra, J. B. L.

doi:10.1002/ajh.23154

Cited by 65 publications

(88 citation statements)

References 32 publications

(41 reference statements)

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“…To the editor: We read with great interest the article by Lammers et al [1] reporting on the clinical value of several markers of altered splenic function (hyposplenism). We also recently performed a study to identify relevant markers of hyposplenism.…”

Section: Reduced Deformability Of Circulating Erythrocytes: a Marker mentioning

confidence: 99%

Reduced deformability of circulating erythrocytes: A marker of hyposplenism

et al. 2012

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Section: Reduced Deformability Of Circulating Erythrocytes: a Marker mentioning

confidence: 99%

Reduced deformability of circulating erythrocytes: A marker of hyposplenism

et al. 2012

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“…The SAE patients who were included were compared to previously studied surgically treated patients and to healthy controls (HC) (17). The serum samples of these patients and controls (who received the same vaccines and tests as did the SAE patients) had been stored, and their levels of antibodies against pneumococcal polysaccharides were reanalyzed, since a new method with new reference values had been introduced.…”

Section: Patientsmentioning

confidence: 99%

“…Three types of B cells were specified: naive cells (IgD (17). Lymphocytes were analyzed only once (before vaccination), since previous work has shown that there were no differences in absolute cell counts or in percentages between pre-and postvaccination samples (17). HJB were made visible in the peripheral blood smear of fresh EDTA blood by Pappenheim (basophilic) staining (combination of May-Grunwald and Giemsa).…”

Section: Patientsmentioning

confidence: 99%

“…Flow cytometric immunophenotyping of B cells was performed on isolated peripheral blood mononuclear cells (PBMCs), incubated with directly labeled fluorescent monoclonal antibodies (17). Three types of B cells were specified: naive cells (IgD (17). Lymphocytes were analyzed only once (before vaccination), since previous work has shown that there were no differences in absolute cell counts or in percentages between pre-and postvaccination samples (17).…”

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Antibody Response to a T-Cell-Independent Antigen Is Preserved after Splenic Artery Embolization for Trauma

Olthof

Lammers

Leeuwen

et al. 2014

Clin. Vaccine Immunol.

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Splenic artery embolization (SAE) is increasingly being used as a nonoperative management strategy for patients with blunt splenic injury following trauma. The aim of this study was to assess the splenic function of patients who were embolized. A clinical study was performed, with splenic function assessed by examining the antibody response to polysaccharide antigens (pneumococcal 23-valent polysaccharide vaccine), B-cell subsets, and the presence of Howell-Jolly bodies (HJB). The data were compared to those obtained from splenectomized patients and healthy controls (HC) who had been included in a previously conducted study. A total of 30 patients were studied: 5 who had proximal SAE, 7 who had distal SAE, 8 who had a splenectomy, and 10 HC. The median vaccine-specific antibody response of the SAE patients (fold increase, 3.97) did not differ significantly from that of the HC (5.29; P ‫؍‬ 0.90); however, the median response of the splenectomized patients (2.30) did differ (P ‫؍‬ 0.003). In 2 of the proximally embolized patients and none of the distally embolized patients, the ratio of the IgG antibody level postvaccination compared to that prevaccination was <2. There were no significant differences in the absolute numbers of lymphocytes or B-cell subsets between the SAE patients and the HC. HJB were not observed in the SAE patients. The splenic immune function of embolized patients was preserved, and therefore routine vaccination appears not to be indicated. Although the median antibody responses did not differ between the patients who underwent proximal SAE and those who underwent distal SAE, 2 of the 5 proximally embolized patients had insufficient responses to vaccination, whereas none of the distally embolized patients exhibited an insufficient response. Further research should be done to confirm this finding.T he spleen is one of the most commonly injured organs after blunt trauma (1, 2). It is involved in the antibody response against infection, most importantly against encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type B, and Neisseria meningitidis group C (3, 4). Other functions of the spleen include storing B and T lymphocytes, plasma cells, and iron and filtering the blood, including removing damaged or old erythrocytes.Surgery (splenectomy) has long been the preferred treatment strategy for patients with traumatic injury to the spleen. After a splenectomy, patients have an increased risk of developing an overwhelming postsplenectomy infection (OPSI), which occurs after only 0.5% of all splenectomies in trauma patients but carries a mortality rate of around 50% to 70% (5). The risk of OPSI was one of the driving factors behind the evolution toward the use of more nonoperative treatment (NOM) strategies for splenic injury.Splenic artery embolization (SAE) is a nonoperative treatment strategy that can be used as an adjunct to observation in cases with an arterial bleeding focus. Advantages of NOM over surgical treatment include the avoidance of surgery-associated complic...

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Prevalence of Immunodeficiency in Children With Invasive Pneumococcal Disease in the Pneumococcal Vaccine Era

et al. 2019

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IMPORTANCE Despite increasing access to vaccination, invasive pneumococcal disease (IPD) is responsible for approximately 826 000 deaths worldwide in children younger than 5 years each year. To allow early identification and prevention, an improved understanding of risk factors for IPD is needed.OBJECTIVES To review the literature on the prevalence of primary immunodeficiency (PID) in children younger than 18 years presenting with IPD without another predisposing condition and to inform guidelines for immunologic evaluation after the first episode of IPD based on published evidence.EVIDENCE REVIEW A literature search of PubMed, Embase (inception [1974] to February 28, 2019), and MEDLINE (inception [1946] to February 28, 2019) was conducted using the terms Streptococcus pneumonia, Streptococcus pneumoniae, pneumococcal infection, Streptococcus infection, pneumococcal meningitis, immunodeficiency, immune response, immunocompromised, susceptib*, precursor, predispose*, recurren*, newborn, neonat*, infan*, toddler, child, preschooler, adolescen*, and pediatric. Publications reporting original data on immunodeficiency in children with microbiologically confirmed primary or recurrent IPD were included. Strength of clinical data was graded according to the 5-point scale of the Oxford Centre for Evidence-Based Medicine.FINDINGS In 6022 unique children with primary IPD, 5 of 393 (1.3%) to 17 of 162 (10.5%) of all children and 14 of 53 (26.4%) of those older than 2 years had a PID identified. Higher rates of PID, up to 10 of 15 (66.7%), were found in children with recurrent IPD. Antibody deficiency was the most common immunodeficiency, followed by complement deficiency, asplenia, and rarer defects in T-cell signaling. The site of infection was a key indicator for the risk of underlying PID, with the greatest risk of PID in children with meningitis or complicated pneumonia. CONCLUSIONS AND RELEVANCEResults of this study suggest that invasive pneumococcal disease, and particularly recurrent IPD, is an important marker of underlying PID in children without other risk factors. The findings also suggest that children older than 2 years with pneumococcal meningitis or complicated pneumonia and all children with recurrent IPD should be referred for an immune evaluation.

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Hyposplenism: Comparison of different methods for determining splenic function

Cited by 65 publications

References 32 publications

Reduced deformability of circulating erythrocytes: A marker of hyposplenism

Reduced deformability of circulating erythrocytes: A marker of hyposplenism

Antibody Response to a T-Cell-Independent Antigen Is Preserved after Splenic Artery Embolization for Trauma

Prevalence of Immunodeficiency in Children With Invasive Pneumococcal Disease in the Pneumococcal Vaccine Era

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