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splenectomy and vaccination

Gross, Ronald Ronald.Gross at baystatehealth.org
Tue Nov 23 14:20:56 GMT 2010


Nikahat,

Your questions are good, but unfortunately have no really good answers.  Having said that, most folks would agree that the vaccines work best prior to splenectomy, and so to answer your 2rd question first one could assume that if you think that a patient has a high likelihood of failing non-operative management (NOM) you could/should vaccinate the patient; whether there is enough time for the vaccine to be effective prior to the (emergency) splenectomy in the face of failed NOM is still questionable.

As to the timing of giving the vaccines post-operatively, there is literature out there that says they should be given at 2 weeks post-op, but it is not Class I evidence.  I tend to give the vaccines in the recovery room (sorry PACU) because (1) our trauma population can be less than "reliable" for follow-up, and I know that they have gotten the vaccines prior to discharge, (2) we don't forget to give the vaccine prior to discharge, and lastly (3) the patient doesn't have a fever from the vaccine that delays discharge and increases their hospital LOS.

Not really good science, but I think it is good medicine, IMHO.

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Nikahat Jahan
Sent: Tuesday, November 23, 2010 9:06 AM
To: Trauma-List [TRAUMA.ORG]
Subject: splenectomy and vaccination

Dear All
1. What is the current guideline on immunizations after emergency
splenectomy. (Pneumococcal, menigococcal, H Infuenza B) and the timing and
type of vaccine- heptavalent conjugated Pneumococcal vaccine Vs 23 valent?
2. Should a trauma patient with splenic injury who is being managed
conservatively- but might end up with a splenectomy later- also recieve
Pneumococcal vaccine?
3. How long should the antibiotic prophylaxis be continued and what drugs
should be used?
thanks
nikahat
-- 
Lt Col Nikahat Jahan
Classified Spl (Anaesthesiology)
Indian Army
--
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