Splenectomy and infection in Hodgkin's disease

Keel, Aileen; Bennett, Bruce; Sarkar, T. K.; Forman, K.; Dawson, Audrey A.; Jones, Peter F.

doi:10.1002/bjs.1800700510

Cited by 14 publications

(3 citation statements)

References 21 publications

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“…Individuals without a spleen run an increased risk of overwhelming infection with high case-fatality for several years after splenectomy (1,(3)(4)(5)(6)(7)(8)(9). More than half these severe infections are due to pneumococci.…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of staging laparotomy with splenectomy in Hodgkin's disease patients in 1969, many reports have focused upon serious postsplenectomy infections (4)(5)(6)(7)(8)(9). When 145 reported postsplenectomy infections in 115 patients were reviewed (7), most cases presented as pneumonia, septicaemia, meningitis or combinations thereof, the most common offending organism being the pneumococcus.…”

Section: Foss Abrahamsen Et Almentioning

confidence: 99%

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Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow‐up study 1994

Abrahamsen

Høiby

Hannisdal

et al. 1997

European J of Haematology

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We surveyed, during 1994, all 325 patients who underwent staging laparotomy with splenectomy for Hodgkin's disease in Norway 1969–80, before pneumococcal vaccine was available in this country. The patients were thus not immunized preoperatively. Of 162 patients (49.8%) who died before 1994, 8 (2.4% of the total study) died from pneumococcal septicaemia and 16 (6.2%) from infections totally. Of 163 patients (50.2%) who were alive in 1994, 158 cooperated and filled in a questionnaire: 22 had been hospitalized for serious infections; 2 with pneumococcal septicaemia, and 6 with pneumonia, although lacking a specified microbiological diagnosis. We observed 325 patients representing 4420 patient‐years, 3066 patient‐years among survivors and 1354 patient‐years among the dead. This resulted in an incidence rate of systemic pneumococcal disease of 226 per 100,000 patient‐years, which is a relative risk of 20.5 compared to the general Norwegian population during 1994. Septicaemia for these patients most often had an abrupt clinical start even for relapse‐free individuals and occurred from 2 to 17 yr after splenectomy (mean 10 yr). The risk of developing an overwhelming pneumococcal septicaemia with high case‐fatality in asplenic patients seems to persist for these patients at about the same level even 15–20 yr after splenectomy. Only 12.7% of the survivors had been given pneumococcal vaccine in the autumn of 1993. Despite the fact that medical journals and media in Norway focused upon the problem of pneumococcal disease in asplenic individuals in the autumn of 1993 and spring of 1994, a substantial proportion of these patients (55.3%) still remained unimmunized when interviewed in the autumn of 1994. None of our systemic pneumococcal disease patients was vaccinated. Our data underline the need for prophylactic immunization with effective vaccines against pneumococcal infection in splenectomized Hodgkin's disease patients.

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Section: Discussionmentioning

confidence: 99%

Section: Foss Abrahamsen Et Almentioning

confidence: 99%

Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow‐up study 1994

Abrahamsen

Høiby

Hannisdal

et al. 1997

European J of Haematology

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“…The incidence of infections was, however, significantly higher in more advanced disease (Abrahamsen et al , 1990). In a study of 84 patients, Keel et al (1983) suggested that aggressive therapy was of greater importance than splenectomy for the risk of infections. In the present study, conducted on 453 patients and with a median follow up of 22·0 years, chemotherapy did not affect the long‐term risk for infections.…”

Section: Risk For Developing Serious Infection Requiring Admission Tmentioning

confidence: 99%

Long term risk of infections in Hodgkin lymphoma long‐term survivors

et al. 2011

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Splenectomy in the management of haematological disease

Dawson

Jones

King

1987

Journal of British Surgery

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Patients, both adults and children, with various haematological disorders who had splenectomy electively in the diagnosis, staging or treatment of their condition during a 15-year period in the Aberdeen hospitals were reviewed. The outcome regarding the disease and the immediate and long-term complications of splenectomy in this group of 185 patients are presented. Splenectomy has an acceptably low morbidity, even in patients with serious haematological disease, in the hands of an experienced surgical team, where there is close co-operation between surgeon and haematologist. Occasionally, late overwhelming infections may occur, despite prophylaxis with penicillin and pneumococcal vaccination. It seems likely that, in their zeal to report such hazards, authors may allow the pendulum against splenectomy to swing too far, in the direction of leaving patients, especially adults, with considerable symptoms and poor health, rather than risk the occasional consequences of the asplenic state.

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Splenectomy and infection in Hodgkin's disease

Cited by 14 publications

References 21 publications

Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow‐up study 1994

Systemic pneumococcal disease after staging splenectomy for Hodgkin's disease 1969–1980 without pneumococcal vaccine protection: a follow‐up study 1994

Long term risk of infections in Hodgkin lymphoma long‐term survivors

Splenectomy in the management of haematological disease

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