306) A 32 year old man with history of immune thrombocytopenic purpura is evaluated in your office during a follow up visit. His previous treatments include intravenous immunoglobulin (IVIG) and steroids for his immune thrombocytopenia. He has responded to IVIG in the past however, the response was transient despite steroid maintenance. The patient was maintained on steroids for 2 months initially and achieved a sub-optimal response with peak platelet count reaching 30k/µl. He began very slow steroid taper over the last 4 weeks but his platelets have dropped to 8k/μl again during the taper. Hence, the patient is scheduled for Splenectomy. On examination, he has no bleeding or echymoses. Platelet count today is 10k/μl. Which of the following is the most appropriate step in preparing this patient for surgery?
A) Pneumococcal , Meningococcal and HIB vaccines 1 week prior to surgery
B) Pneumococcal and meningococcal vaccines 2 weeks prior to surgery
C) Pneumococcal, Menigococcal and HIB vaccines 2 weeks prior to surgery
D) Daily oral Penicillin Prophylaxis
E) No vaccines required in adults
E
B) Pneumococcal and meningococcal vaccines 2 weeks prior to surger
b
c
C……..Persons who have had a splenectomy or who have functional asplenia are at increased risk for infection with encapsulated bacteria. Therefore, age-appropriate pneumococcal, meningococcal, and possibly Haemophilus influenzae (Hib) vaccinations should be given 14 days prior to a scheduled splenectomy or after the 14th postoperative day.
The CDC recommends annual influenza vaccine as well, because secondary bacterial infections can lead to severe disease in this patient population. Boosters are recommended for all bacterial vaccines every five years for asplenic patients.
MMR contains live viral antigens but is not contraindicated in asplenic patients. Between 2% and 5% of persons do not develop measles immunity after the first dose of the vaccine. The second dose is not a “booster” but another chance to develop immunity. No further administration of MMR is necessary after two doses
This recomendation is base of Class III evidence: Retrospective study. Includes database or registry reviews, large series of case reports, expert opinion.
• Technology assessment: A technology study which does not lend itself to classification in the above-mentioned format.
Devices are evaluated in terms of their accuracy, reliability, therapeutic potential, or cost effectiveness.
Do adults need H influenza vaccine???