OALibJ  Vol.2 No.7 , July 2015
Overwhelming Postsplenectomy Infection for Splenectomized HCV Patients
Abstract: Pegylated-interferon (IFN) plus ribavirin remains the most effective therapeutic regimen for patients with chronic hepatitis C interferon. Thrombocytopenia is a common side effect of this treatment, often leading to discontinuation of a potentially curative therapy. Splenectomy was a clinically effective treatment for hepatitis C virus-associated thrombocytopenia. Splenectomy in patients with hepatitis C cirrhosis is now safer prelude to antiviral treatment. Overwhelming post splenectomy infection (OPSI) syndrome is a rare condition, but is associated with high mortality. However, recognition and clinical management of OPSI is not well established. We reviewed the literature characterizing the clinicopathological features of OPSI and assessed the most effective and feasible administration of the condition. Prevention strategies such as vaccination and education are also potentially important parts of the strategy for splenectomized HCV patients.
Cite this paper: Hashimoto, N. (2015) Overwhelming Postsplenectomy Infection for Splenectomized HCV Patients. Open Access Library Journal, 2, 1-5. doi: 10.4236/oalib.1101711.

[1]   Anonymous (1999) Hepatitis C-Global Prevalence (Update). World Health Organization Weekly Epidemiological Record, 74, 425-427.

[2]   McHutchison, J.G., Goodman, Z.D., Ling, M.H., et al. (1998) Interferon Alfa-2b Alone or in Combination with Ribavirin as Initial Treatment for Chronic Hepatitis C. Hepatitis Interventional Therapy Group. The New England Journal of Medicine, 339, 1485-1492.

[3]   Youngster, S., Wang, Y.S., Grace, M., et al. (2002) Structure, Biology and Therapeutic Implications of Pegylated Interferon Alpha-2b. Current Pharmaceutical Design, 8, 2139-2157.

[4]   Fried, M.W., Shiffman, M.L., Reddy, K.R., et al. (2002) Peginterferon Alfa-2a plus Ribavirin for Chronic Hepatitis C Virus Infection. The New England Journal of Medicine, 347, 975-982.

[5]   McHutchison, J.G., Manns, M., Patel, K., et al. (2002) Adherence to Combination Therapy Enhances Sustained Response in Genotype-1-Infected Patients with Chronic Hepatitis C. Gastroenterology, 123, 1061-1069.

[6]   Kamal, S.M., EI Kamary, S.S., Shardel, M.D., et al. (2007) Pegylated Interferon Alpha-2b plus Ribavirin in Patients with Genotype 4 Chronic Hepatitis C: The Role of Rapid and Early Virologic Response. Hepatology, 46, 1732-1740.

[7]   Di Bisceglie, A.M. and Hoofnagle, J.H. (2002) Optimal Therapy of Hepatitis C. Hepatology, 36, S121-127.

[8]   Hayashi, P.H., Mehia, C., Joachim Reimers, H., et al. (2006) Splenectomy for Thrombocytopenia in Patients with Hepatitis C Cirrhosis. Journal of Clinical Gastroenterology, 40, 740-744.

[9]   Renault, P.F. and Hoofnagle, J.H. (1989) Side Effects of Alpha Interferon. Seminars in Liver Disease, 9, 273-277.

[10]   Martin, T.G. and Shuman, M.A. (1998) Interferon-Induced Thrombocytopenia; It Is Time for Thrombopoietin. Hepatology, 28, 1430-1432.

[11]   Maddison, F.E. (1973) Embolic Therapy of Hypersplenism. Investigative Radiology, 8, 280-281.

[12]   Moges, M.F., Spigos, D.G., Pollak, R., Abejo, R., Pavel, D.G., Tan, W.S. and Jonasson, O. (1984) Partial Splenic Embolization, an Alternative to Splenectomy—Results of a Prospective, Randomized Study. Surgery, 96, 694-702.

[13]   Pålsson, B. and Verbaan, H. (2005) Partial Splenic Embolization as Pretreatment for Antiviral Therapy in Hepatitis C Virus Infection. European Journal of Gastroenterology & Hepatology, 17, 1157-1164.

[14]   Kercher, K.W., Carbonell, A.M., Heniford, B.T., Matthews, B.D., Cunningham, D.M. and Reindollar, R.W. (2004) Laparoscopic Splenectomy Reverses Thrombocytopenia in Patients with Hepatitis C Cirrhosis and Portal Hypertension. Journal of Gastrointestinal Surgery, 8, 120-126.

[15]   King, H., Shumacker Jr., H.B. (1952) Splenic Studies: I. Susceptibility to Infection after Splenectomy Performed Infancy. Annals of Surgery, 136, 239-242.

[16]   Evans, D.I. (1985) Postsplenectomy Sepsis 10 Years or More after Operation. Journal of Clinical Pathology, 38, 309-311.

[17]   Cullingford, G.L., Watkins, D.N., Watts, A.D. and Mallon, D.F. (1991) Severe Late Postsplenectomy Infection. British Journal of Surgery, 78, 716-721.

[18]   Jockovich, M., Mendenhall, N.P., Somebeck, M.D., Talbert, J.L., Copeland III, E.M. and Bland, K.I. (1994) Long-Term Complications of Laparotomy in Hodgkin’s Disease. Annals of Surgery, 219, 615-621.

[19]   Landgren, O., Bjorkholm, M., konradsen, H.B., Söderqvist, M., Nilsson, B. and Gustavsson, A. (2004) A Prospective Study on Antibody Response to Repeated Vaccinations with Pneumococcal Capsular Polysaccharide in Splentomized Individuals with Special Reference to Hodgkin’s Lymphoma. Journal of Internal Medicine, 255, 664-673.

[20]   Shatz, D.V. (2005) Vaccination Considerations in the Asplenic Patient. Expert Review of Vaccines, 4, 27-34.

[21]   White, K.S., Covington, D., Churchill, P., Maxwell, J.G., Norman, K.S. and Clancy, T.V. (1991) Patient Awareness of Health Precautions after Splenectomy. American Journal of Infection Control, 19, 36-41.