Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline.
antibiotic(s)
asplenia
hyposplenism
infection
partial splenectomy
registry
splenectomy
splenic embolisation
vaccination
Journal
British journal of haematology
ISSN: 1365-2141
Titre abrégé: Br J Haematol
Pays: England
ID NLM: 0372544
Informations de publication
Date de publication:
10 Apr 2024
10 Apr 2024
Historique:
revised:
13
02
2024
received:
15
12
2023
accepted:
15
02
2024
medline:
11
4
2024
pubmed:
11
4
2024
entrez:
11
4
2024
Statut:
aheadofprint
Résumé
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non-infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti-microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 British Society for Haematology and John Wiley & Sons Ltd.
Références
Working Party of the British Committee for Standards in Haematology Clinical Haematology Task Force. Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. BMJ. 1996;312:430–434.
Davies JM, Lewis MPN, Wimperis J, Rafi I, Ladhani S, Bolton‐Maggs PHB. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato‐Oncology Task Force. Br J Haematol. 2011;155:308–317.
Department of Health. The UK Immunisation Schedule [Internet]. 2022. [cited 1 March 2024]. Available from: https://www.gov.uk/government/collections/immunisation‐against‐infectious‐disease‐the‐green‐book
Leston M, Elson WH, Watson C, Lakhani A, Aspden C, Bankhead CR, et al. Representativeness, vaccination uptake, and COVID‐19 clinical outcomes 2020–2021. JMIR Public Health Surveill. 2022;8:e39141.
William BM, Corazza GR. Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology. 2007;12:1–13.
William BM, Thawani N, Sae‐Tia S, Corazza GR. Hyposplenism: a comprehensive review. Part II: clinical manifestations, diagnosis, and management. Hematology. 2007;12:89–98.
Lenti MV, Luu S, Carsetti R, Osier F, Ogwang R, Nnodu OE, et al. Asplenia and spleen hypofunction. Nat Rev Dis Primers. 2022;8:70–71.
Kirkineska L, Perifanis V, Vasiliadis T. Functional hyposplenism. Hippokratia. 2014;18:7–11.
Scheuerman O, Bar‐Sever Z, Hoffer V, Gilad O, Marcus N, Garty BZ. Functional hyposplenism is an important and underdiagnosed immunodeficiency condition in children. Acta Paediatr. 2014;103:e399–e403.
Nakagami Y, Uchino K, Okada H, Suzuki K, Enomoto M, Mizuno S, et al. Potential role of Howell‐Jolly bodies in identifying functional hyposplenism: a prospective single‐institute study. Int J Hematol. 2020;112:544–552.
Ishikawa T, Kubota T, Horigome R, Kimura N, Honda H, Iwanaga A, et al. Prevalence of Howell‐Jolly bodies caused by partial splenic embolization for portal hypertension. Intern Med. 2013;52:1765–1768.
McBride JA, Dacie JV, Shapley R. The effect of splenectomy on the leucocyte count. Br J Haematol. 1968;14:225–231.
Corazza GR, Ginaldi L, Zoli G, Frisoni M, Lalli G, Gasbarrini G, et al. Howell‐Jolly body counting as a measure of splenic function. A reassessment. Clin Lab Haematol. 1990;12:269–275.
Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long‐term risks after splenectomy among 8,149 cancer‐free American veterans: a cohort study with up to 27 years follow‐up. Haematologica. 2014;99:392–398.
Meier‐Stephenson V, McNeil S, Kew A, Sweetapple J, Thompson K, Slayter K. Effects of a pharmacy‐driven perisplenectomy vaccination program on vaccination rates and adherence to guidelines. Can J Hosp Pharm. 2014;67:262–267.
Rihtarchik L, Murphy CV, Porter K, Mostafavifar L. Utilizing pharmacy intervention in asplenic patients to improve vaccination rates. Res Social Adm Pharm. 2018;14:367–371.
Lammers AJJ, Hoekstra JBL, Speelman P, Lombarts KMJMH. Physicians report barriers to deliver best practice care for asplenic patients: a cross‐sectional survey. PLoS One. 2011;6:e17302.
Starnoni M, Pappalardo M, Marra C, Pinelli M, De Santis G. The overwhelming postsplenectomy sepsis: role of plastic surgeon. Plast Reconstr Surg Glob Open. 2023;11:e5109.
Belli AK, Dönmez C, Özcan Ö, Dere Ö, Dirgen Çaylak S, Dinç Elibol F, et al. Adherence to vaccination recommendations after traumatic splenic injury. Ulus Travma Acil Cerrahi Derg. 2018;24:337–342.
Alvarado AR, Udobi K, Berry S, Assmann J, McDonald T, Winfield RD. An opportunity for improvement in trauma care: 8‐week booster vaccination adherence among patients after trauma splenectomy. Surgery. 2018;163:415–418.
Crooker KG, Howard JM, Alvarado AR, McDonald TJ, Berry SD, Green JL, et al. Splenic embolization after trauma: an opportunity to improve best immunization practices. J Surg Res. 2018;232:293–297.
Gasparetto A, Hunter D, Sapoval M, Sharma S, Golzarian J. Splenic embolization in trauma: results of a survey from an international cohort. Emerg Radiol. 2021;28:955–963.
Skattum J, Loekke RJV, Titze TL, Bechensteen AG, Aaberge IS, Osnes LT, et al. Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study. Injury. 2014;45:156–159.
Skattum J, Titze TL, Dormagen JB, Aaberge IS, Bechensteen AG, Gaarder PI, et al. Preserved splenic function after angioembolisation of high grade injury. Injury. 2012;43:62–66.
Slater SJ, Lukies M, Kavnoudias H, Zia A, Lee R, Bosco JJ, et al. Immune function and the role of vaccination after splenic artery embolization for blunt splenic injury. Injury. 2022;53:112–115.
Lukies M, Zia A, Kavnoudias H, Bosco JJ, Narita C, Lee R, et al. Immune function after splenic artery embolization for blunt trauma: long‐term assessment of CD27(+) IgM B‐cell levels. J Vasc Interv Radiol. 2022;33:505–509.
Lee GM. Preventing infections in children and adults with asplenia. Hematology Am Soc Hematol Educ Program. 2020;2020:328–335.
Camejo L, Nandeesha N, Phan K, Chharath K, Tran T, Ciesla D, et al. Infectious outcomes after splenectomy for trauma, splenectomy for disease and splenectomy with distal pancreatectomy. Langenbeck's Arch Surg. 2022;407:1685–1691.
Contou D, Coudroy R, Colin G, Tadié JM, Cour M, Sonneville R, et al. Pneumococcal purpura fulminans in asplenic or hyposplenic patients: a French multicenter exposed‐unexposed retrospective cohort study. Crit Care. 2020;24:68.
Kealey GP, Dhungel V, Wideroff MJ, Liao J, Choi K, Skeete DA, et al. Patient education and recall regarding postsplenectomy immunizations. J Surg Res. 2015;199:580–585.
Bianchi FP, Stefanizzi P, Di Lorenzo A, Cuscianna E, Tafuri S, Germinario CA. Vaccine coverage for recommended vaccines among splenectomised patients in Apulia, South Italy: a retrospective cohort study. BMJ Open. 2023;13:e069316.
Bianchi FP, Stefanizzi P, Spinelli G, Mascipinto S, Tafuri S. Immunization coverage among asplenic patients and strategies to increase vaccination compliance: a systematic review and meta‐analysis. Expert Rev Vaccines. 2021;20:297–308.
Carrico RM, Goss L, Wojcik J, Broughton‐Miller K, Pentecost K, Frisbie M, et al. Postsplenectomy vaccination guideline adherence: opportunities for improvement. J Am Assoc Nurse Pract. 2017;29:612–617.
Piccinelli G, Caccuri F, De Peri E, Tironi A, Odolini S, Notarangelo LD, et al. Fulminant septic shock caused by Capnocytophaga canimorsus in Italy: case report. Int J Infect Dis. 2018;72:3–5.
Bach O, Baier M, Pullwitt A, Fosiko N, Chagaluka G, Kalima M, et al. Falciparum malaria after splenectomy: a prospective controlled study of 33 previously splenectomized Malawian adults. Trans R Soc Trop Med Hyg. 2005;99:861–867.
Oniyangi O, Omari AA. Malaria chemoprophylaxis in sickle cell disease. Cochrane Database Syst Rev. 2019;2019:CD003489.
Patel RR, Liang SY, Koolwal P, Kuhlmann FM. Travel advice for the immunocompromised traveler: prophylaxis, vaccination, and other preventive measures. Ther Clin Risk Manag. 2015;11:217–228.
Downing MA, Omar AH, Sabri E, McCarthy AE. Information on the internet for asplenic patients: a systematic review. Can J Surg. 2011;54:232–236.
Bayrhuber M, Anka N, Camp J, Glattacker M, Farin E, Rieg S. Prevention of post‐splenectomy sepsis in patients with asplenia – a study protocol of a controlled trial. BMC Infect Dis. 2020;20:41.
Anka N, Glattacker M, Farin‐Glattacker E, Camp J, Rieg S, Bayrhuber M. Patients' with asplenia and doctors' experiences in implementing preventative measures following a novel educational intervention: a qualitative analysis. BMJ Open. 2022;12:e060492.
O'Neill NE, Baker J, Ward R, Johnson C, Taggart L, Sholzberg M. The development of a quality improvement project to improve infection prevention and management in patients with asplenia or hyposplenia. BMJ Open Quality. 2020;9:e000770.
Quéffélec C, Billet L, Duffau P, Lazaro E, Machelart I, Greib C, et al. Prevention of infection in asplenic adult patients by general practitioners in France between 2013 and 2016: care for the asplenic patient in general practice. BMC Fam Pract. 2020;21:163.
Horvat M, Robnik B, Bizjak K, Vuzem S, Miksić NG. Audit of post‐splenectomy prophylaxis in a single tertiary center in Slovenia: where are we and what should be done? Surg Infect. 2021;22:292–298.
Woolley I, Jones P, Spelman D, Gold L. Cost‐effectiveness of a post‐splenectomy registry for prevention of sepsis in the asplenic. Aust N Z J Public Health. 2006;30:558–561.
Arnott A, Jones P, Franklin LJ, Spelman D, Leder K, Cheng AC. A registry for patients with asplenia/hyposplenism reduces the risk of infections with encapsulated organisms. Clin Infect Dis. 2018;67:557–561.
Luu S, Dendle C, Jones P, Ojaimi S, Woolley IJ. Impact of a spleen registry on optimal post‐splenectomy vaccination and care. Hum Vaccin Immunother. 2018;14:2894–2899.
Kanhutu K, Jones P, Cheng AC, Grannell L, Best E, Spelman D. Spleen Australia guidelines for the prevention of sepsis in patients with asplenia and hyposplenism in Australia and New Zealand. Intern Med J. 2017;47:848–855.
Luu S, Sheldon J, Dendle C, Ojaimi S, Jones P, Woolley I. Prevalence and distribution of functional splenic tissue after splenectomy. Intern Med J. 2020;50:556–564.
Guizzetti L. Total versus partial splenectomy in pediatric hereditary spherocytosis: a systematic review and meta‐analysis. Pediatr Blood Cancer. 2016;63:1713–1722.
Pozdeyev N, Patel A, Pottinger PS, Leu M, Payne TH. Adherence to recommended post‐splenectomy immunizations to reduce the risk of sepsis: the University of Washington experience. Am J Med Qual. 2020;35:405–410.
Premawardena C, Bowden D, Kaplan Z, Dendle C, Woolley IJ. Understanding of the significance and health implications of asplenia in a cohort of patients with haemaglobinopathy: possible benefits of a spleen registry. Hematology. 2018;23:526–530.
Wang J, Jones P, Cheng AC, Leder K. Adherence to infection prevention measures in a statewide spleen registry. Med J Aust. 2014;200:538–540.
Bolton‐Maggs PH, Stevens RF, Dodd NJ, Tittensor P, King MJ; General Haematology Task Force of the British Committee for Standards in Haematology. Guidelines for the diagnosis and management of hereditary spherocytosis. Br J Haematol. 2004;126:455–474.
Infanti LM, Elder JJ, Franco K, Simms S, Statler VA, Raj A. Immunization adherence in children with sickle cell disease: a single‐institution experience. J Pediatr Pharmacol Ther. 2020;25:39–46.
Rubin LG, Schaffner W. Clinical practice. Care of the asplenic patient. N Engl J Med. 2014;371:349–356.
Vila‐Corcoles A, Salsench E, Rodriguez‐Blanco T, Ochoa‐Gondar O, de Diego C, Valdivieso A, et al. Clinical effectiveness of 23‐valent pneumococcal polysaccharide vaccine against pneumonia in middle‐aged and older adults: a matched case‐control study. Vaccine. 2009;27:1504–1510.
Djennad A, Ramsay ME, Pebody R, Fry NK, Sheppard C, Ladhani SN, et al. Effectiveness of 23‐valent polysaccharide pneumococcal vaccine and changes in invasive pneumococcal disease incidence from 2000 to 2017 in those aged 65 and over in England and Wales. EClinicalMedicine. 2018;6:42–50.
Waight PA, Andrews NJ, Ladhani SN, Sheppard CL, Slack MP, Miller E. Effect of the 13‐valent pneumococcal conjugate vaccine on invasive pneumococcal disease in England and Wales 4 years after its introduction: an observational cohort study. Lancet Infect Dis. 2015;15:535–543.
Miller E, Andrews N, Waight P, Slack M, George RC. Herd immunity and serotype replacement 4 years after seven‐valent pneumococcal conjugate vaccination in England and Wales: an observational cohort study. Lancet Infect Dis. 2011;11:760–768.
Ladhani SN, Collins S, Djennad A, Sheppard CL, Borrow R, Fry NK, et al. Rapid increase in non‐vaccine serotypes causing invasive pneumococcal disease in England and Wales, 2000–17: a prospective national observational cohort study. Lancet Infect Dis. 2018;18:441–451.
Brueggemann AB, Jansen van Rensburg MJ, Shaw D, McCarthy ND, Jolley KA, Maiden MCJ, et al. Changes in the incidence of invasive disease due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis during the COVID‐19 pandemic in 26 countries and territories in the Invasive Respiratory Infection Surveillance initiative: a prospective analysis of surveillance data. Lancet Digit Health. 2021;3:e360–e370.
Bertran M, Amin‐Chowdhury Z, Sheppard CL, Eletu S, Zamarreño DV, Ramsay ME, et al. Increased incidence of invasive pneumococcal disease among children after COVID‐19 pandemic, England. Emerg Infect Dis. 2022;28:1669–1672.
Amin‐Chowdhury Z, Aiano F, Mensah A, Sheppard CL, Litt D, Fry NK, et al. Impact of the coronavirus disease 2019 (COVID‐19) pandemic on invasive pneumococcal disease and risk of pneumococcal coinfection with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2): prospective National Cohort Study, England. Clin Infect Dis. 2021;72:e65–e75.
Smets F, Bourgois A, Vermylen C, Brichard B, Slacmuylders P, Leyman S, et al. Randomised revaccination with pneumococcal polysaccharide or conjugate vaccine in asplenic children previously vaccinated with polysaccharide vaccine. Vaccine. 2007;25:5278–5282.
Takeshita K, Takeuchi N, Takahashi Y, Fukasawa C, Hishiki H, Hoshino T, et al. Pneumococcal serotype‐specific IgG and opsonophagocytic activity in young Japanese patients with asplenia. Hum Vaccin Immunother. 2021;17:3687–3691.
Papadatou I, Orthopoulos G, Theodoridou M, Spoulou V. Long‐lasting hyporesponsivenss induced by the 23‐valent pneumococcal polysaccharide vaccine (PPV23) in asplenic patients with beta‐thalassemia major. Vaccine. 2015;33:3779–3783.
UK Health Security Agency. Vaccination of Individuals with Uncertain or Incomplete Immunisation Status [Internet]. 2013. [cited 1 March 2024]. Available from: https://www.gov.uk/government/publications/vaccination‐of‐individuals‐with‐uncertain‐or‐incomplete‐immunisation‐status
Musher DM, Anderson R, Feldman C. The remarkable history of pneumococcal vaccination: an ongoing challenge. Pneumonia (Nathan). 2022;14:5.
Andrews NJ, Waight PA, Burbidge P, Burbidge P, Pearce E, Roalfe L, et al. Serotype‐specific effectiveness and correlates of protection for the 13‐valent pneumococcal conjugate vaccine: a postlicensure indirect cohort study. Lancet Infect Dis. 2014;14:839–846.
Stanford E, Print F, Falconer M, Lamden K, Ghebrehewet S, Phin N, et al. Immune response to pneumococcal conjugate vaccination in asplenic individuals. Hum Vaccin. 2009;5:85–91.
Shatz DV, Schinsky MF, Pais LB, Romero‐Steiner S, Kirton OC, Carlone GM. Immune responses of splenectomized trauma patients to the 23‐valent pneumococcal polysaccharide vaccine at 1 versus 7 versus 14 days after splenectomy. J Trauma. 1998;44:760–765; discussion 765–766.
Pao M, Papadopoulos EB, Chou J, Glenn H, Castro‐Malaspina H, Jakubowski AA, et al. Response to pneumococcal (PNCRM7) and Haemophilus influenzae conjugate vaccines (HIB) in pediatric and adult recipients of an allogeneic hematopoietic cell transplantation (alloHCT). Biol Blood Marrow Transplant. 2008;14:1022–1030.
Collins S, Litt D, Almond R, Findlow J, Linley E, Ramsay M, et al. Haemophilus influenzae type b (Hib) seroprevalence and current epidemiology in England and Wales. J Infect. 2018;76:335–341.
The Joint Committee on Vaccination and Immunisation. Independent Report JCVI Interim Statement on Changes to the Childhood Immunisation Schedule [Internet]. 2022. [cited 1 March 2024]. Available from: https://www.gov.uk/government/publications/jcvi‐interim‐statement‐on‐changes‐to‐the‐childhood‐immunisation‐schedule
Parikh SR, Campbell H, Bettinger JA, Harrison LH, Marshall HS, Martinon‐Torres F, et al. The everchanging epidemiology of meningococcal disease worldwide and the potential for prevention through vaccination. J Infect. 2020;81:483–498.
Sherman AC, Stephens DS. Serogroup A meningococcal conjugate vaccines: building sustainable and equitable vaccine strategies. Expert Rev Vaccines. 2020;19:455–463.
Campbell H, Andrews N, Parikh SR, White J, Edelstein M, Bai X, et al. Impact of an adolescent meningococcal ACWY immunisation programme to control a national outbreak of group W meningococcal disease in England: a national surveillance and modelling study. Lancet Child Adolesc Health. 2022;6:96–105.
Ladhani SN, Andrews N, Parikh SR, Campbell H, White J, Edelstein M, et al. Vaccination of infants with meningococcal group B vaccine (4CMenB) in England. N Engl J Med. 2020;382:309–317.
Mensah AA, Campbell H, Clark SA, Ribeiro S, Lucidarme J, Bai X, et al. Outcomes of meningococcal serogroup B disease in children after implementation of routine infant 4CMenB vaccination in England: an active, prospective, national surveillance study. Lancet Child Adolesc Health. 2023;7:190–198.
Ladhani SN, Campbell H, Andrews N, Parikh SR, White J, Edelstein M, et al. First real‐world evidence of meningococcal group B vaccine, 4CMenB, protection against meningococcal group W disease: prospective enhanced National Surveillance, England. Clin Infect Dis. 2021;73:e1661–e1668.
Ruiz Garcia Y, Sohn WY, Seib KL, Taha M‐K, Vázquez JA, de Lemos APS, et al. Looking beyond meningococcal B with the 4CMenB vaccine: the Neisseria effect. NPJ Vaccines. 2021;6:130.
Marshall HS, McMillan M, Koehler AP, Lawrence A, Sullivan TR, MacLennan JM, et al. Meningococcal B vaccine and meningococcal carriage in adolescents in Australia. N Engl J Med. 2020;382:318–327.
Burman C, Alderfer J, Snow VT. A review of the immunogenicity, safety and current recommendations for the meningococcal serogroup B vaccine, MenB‐FHbp. J Clin Pharm Ther. 2020;45:270–281.
Snape MD, Kelly DF, Lewis S, Banner C, Kibwana L, Moore CE, et al. Seroprotection against serogroup C meningococcal disease in adolescents in the United Kingdom: observational study. BMJ. 2008;336:1487–1491.
Green Book Chapter 19: Influenza [Internet]. [cited 1 March 2024]. Available from: https://assets.publishing.service.gov.uk/media/654cf306014cc90010677371/Green‐book‐chapter‐19‐influenza‐_3November2023.pdf
NHS. Getting a COVID‐19 Vaccine [Internet]. [cited 1 March 2024]. Available from: https://www.nhs.uk/conditions/covid‐19/covid‐19‐vaccination/getting‐a‐covid‐19‐vaccine/
Cummins D, Heuschkel R, Davies SC. Penicillin prophylaxis in children with sickle cell disease in Brent. BMJ. 1991;302:989–990.
Riddington C, Owusu‐Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Syst Rev. 2002;2002:CD003427.
Hirst C, Owusu‐Ofori S. Prophylactic antibiotics for preventing pneumococcal infection in children with sickle cell disease. Cochrane Database Syst Rev. 2014;2014:CD003427.
Malangoni MA, Dillon LD, Klamer TW, Condon RE. Factors influencing the risk of early and late serious infection in adults after splenectomy for trauma. Surgery. 1984;96:775–783.
Cherif H, Landgren O, Konradsen HB, Kalin M, Bjorkholm M. Poor antibody response to pneumococcal polysaccharide vaccination suggests increased susceptibility to pneumococcal infection in splenectomized patients with hematological diseases. Vaccine. 2006;24:75–81.
Eber SW, Langendorfer CM, Ditzig M, Reinhardt D, Stöhr G, Soldan W, et al. Frequency of very late fatal sepsis after splenectomy for hereditary spherocytosis: impact of insufficient antibody response to pneumococcal infection. Ann Hematol. 1999;78:524–528.
Meerveld‐Eggink A, de Weerdt O, Rijkers GT, van Velzen‐Blad H, Biesma DH. Vaccination coverage and awareness of infectious risks in patients with an absent or dysfunctional spleen in The Netherlands. Vaccine. 2008;26:6975–6979.
Keenan RD, Boswell T, Milligan DW. Do post‐splenectomy patients take prophylactic penicillin? Br J Haematol. 1999;105:509–510.
Falletta JM, Woods GM, Verter JI, Buchanan GR, Pegelow CH, Iyer RV, et al. Discontinuing penicillin prophylaxis in children with sickle cell anemia. Prophylactic penicillin study II. J Pediatr. 1995;127:685–690.
Sickle Cell Society. Standards for the Clinical Care of Adults with Sickle Cell Disease in the UK [Internet]. 2018. https://www.sicklecellsociety.org/wp‐content/uploads/2018/05/Standards‐for‐the‐Clinical‐Care‐of‐Adults‐with‐Sickle‐Cell‐in‐the‐UK‐2018.pdf
Kyaw MH, Holmes EM, Toolis F, Wayne B, Chalmers J, Jones IG, et al. Evaluation of severe infection and survival after splenectomy. Am J Med. 2006;119(276):e1–e7.
Lammers AJ, de Porto AP, Bennink RJ, van Leeuwen EM, Biemond BJ, Goslings JC, et al. Hyposplenism: comparison of different methods for determining splenic function. Am J Hematol. 2012;87:484–489.
Di Sabatino A, Carsetti R, Corazza GR. Post‐splenectomy and hyposplenic states. Lancet. 2011;378:86–97.
Sills RH. Splenic function: physiology and splenic hypofunction. Crit Rev Oncol Hematol. 1987;7:1–36.
Spencer RP, Gupta SM. The spleen: diagnosis of splenic diseases using radiolabeled tracers. Crit Rev Clin Lab Sci. 1989;27:299–318.
Peters AM, Ryan PF, Klonizakis I, Elkon KB, Lewis SM, Hughes GR. Measurement of splenic function in humans using heat damaged autologous red blood cells. Scand J Haematol. 1981;27:374–380.