title: Fulminant sepsis in adults splenectomized for idiopathic thrombocytopenic purpura.
abstract: METHODS
  Splenectomy is still a mainstay in the treatment of idiopathic thrombocytopenic purpura (ITP). Although the risk of fulminant sepsis after splenectomy in children and in adults has been known for a long time, the true prevalence of fulminant sepsis in adults splenectomized for ITP has still not been well established, despite many anecdotal reports. In this paper we have tried to estimate this risk by reviewing the available literature and by analyzing a large cohort of adults splenectomized for ITP at our Institute since 1970.
  
  
  RESULTS
  Two cases of fulminant sepsis (a 21-year-old man and a 24-year-old woman) were traced in a group of 133 splenectomized adults, with a crude incidence of 1.5% or, equivalently, of 0.17 cases per 100 patient-years. No case of sepsis occurred in a control group of 323 non splenectomized ITP adults. This estimation seems sufficiently precise for the large population analyzed and the duration and completeness of follow-up (1,126 patient-years, mean 101 months, 2 patients lost from follow-up), and it is in agreement with the estimations yielded by a literature review (1.8%).
  
  
  CONCLUSIONS
  The risk of fulminant sepsis seems to be a real hazard in adults splenectomized for ITP, and a conservative approach in recommending splenectomy seems advisable. Antipneumococcal vaccination should also be recommended.
authors.affiliation: Dipartimento di Ematologia, Ospedale San Bortolo, Vicenza, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Rodeghiero
authors.forename: M
authors.initials: M
authors.lastname: Frezzato
authors.forename: C
authors.initials: C
authors.lastname: Schiavotto
authors.forename: G
authors.initials: G
authors.lastname: Castaman
authors.forename: E
authors.initials: E
authors.lastname: Dini
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000601:surgery; D012306:Risk; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology*; D013156:Splenectomy
chemical_list: D000305:Adrenal Cortex Hormones