Influence of Splenectomy on Immunity in Child Age

Overview

The authors present influence of splenectomy (SE) on immune profile in a grup of 73 patients (mean age9.95±3.4 years) examined in 1989-2001. They were divided according to diagnoses into three groups: 1st - haemolyticanaemia (HA) (32 patients), 2nd - idiopatic thrombocytopenic purpura (ITP) (30 patients) and 3rd - rupture ofthe spleen (11 patients). Control group involved 30 children.Changes of immune parameters were observed in the groups of patients with HA and ITP and controls beforeSE. Changes of immune profiles after SE in all three groups were observed considering the interval from SE (6weeks, 6 months, and 1-10 years) to check-up.The most significant changes resulting from SE were found in cellular specific immunity with CD4/CD8 ratiodecreasing, decrease of helper CD4+ T-lymphocytes percentage, decrease of naive CD45+RA+CD4+ T-lymphocytesin all three groups of patients. After SE decrease of microbicidal activity of neutrophils was found in the patientswith HA and ITP and in all groups of patients decrease of phagocytic activities of neutrophils was found. Thesignificant decrease of IgM was found in the group of patients with ITP and HA till seven and eight years after SE.From further opsonins, that was a significant decrease of C3 component of the complement, which is an essentialindicator of monitoring after SE.On the basis of the above findings the authors recommend to monitor all stated laboratory parameters,recommend 3 years of antibiotic prophylaxis afterSE in patients with haematological diseases and 1 year in patientsafter SE due to rupture of the spleen with good immune profile. For patients with immunodeficiency it isrecommended to take antibiotic prophylaxis until adjustment of immunodeficiency providing lifelong availabilityof a broad-spectrum antibiotic in case of acute infection.

Key words:
splenectomy, cellular specific immunity, humoral immunity, microbicidal and phagocytic activity,haematological diseases