Overwhelming postsplenectomy sepsis and trauma: Time to consider revaccination?

Absence of the spleen predisposes individuals to risk of overwhelming infection, most often because of encapsulated organisms. The risk is greatest in infants and young children, but many remain unaware of the risk to asplenic or hyposplenic adults who many have no underlying medical problems.' Immunization with pneumococcal, Haemophilus influenzae, and meningococcal vaccines have reduced the incidence of infections in asplenic and hyposplenic individuals, but these measures have not eliminated the risk. Furthermore, recent data suggest that currently accepted best practice for managing asplenic patients is not being followed.(2) This case report describes a recent adult patient who developed overwhelming postsplenectomy pneumococcal sepsis with disseminated intravascular coagulation, resulting in limb loss. Specific issues regarding efficacy of vaccination, current best practice and preventive measures, and patient education in postsplenectomy trauma patients are discussed.