title: Post traumatic splenic function depending on severity of injury and management.
abstract: Because splenectomy has been linked to overwhelming infection years ago, management of splenic traumatisms has become progressively conservative. To assess the immunological function of the spleen in patients with splenic traumatism of different intensity, 43 patients with splenic injury (grades I through V) undergoing either nonoperative management, splenectomy, splenectomy with autotransplantation, or splenic embolization were analyzed for lymphocyte subpopulations and antibody responses to Streptococcus pneumoniae and Haemophilus influenzae vaccinations. Patients treated with splenectomy exhibited a significant decrease in CD4+ T lymphocytes and in Immunoglobulin (Ig) M(high)IgD(low) B cells (related to T-cell independent responses). Median fluorescence intensity of CD54+ in B cells also was reduced. The percent of IgM(high)IgD(low) B cells-a marker of marginal zone function-was inversely correlated with the number of pitted-red blood cells-a marker of red pulp function loss. IgM anti-S pneumoniae identified those patients with a defective rapid response to polysaccharide antigens. These results reinforce the importance of conservative options in the treatment of splenic traumatism for even a severely damaged organ. Despite the significant differences among the groups reported, it remains difficult to predict the IgM response to S pneumoniae vaccine of the individual patients. Better markers to assess splenic function and vaccination response after severe splenic traumatism-even in patients with nonoperative management-might improve risk assessment for overwhelming postsplenectomy infection.
authors.affiliation: Department of Surgery, University Hospital Germans Trias i Pujol, Health Science Research Institute Germans Trias i Pujol, Faculty of Medicine, Universitat Autònoma Barcelona, Barcelona, Spain.
authors.forename: Benjamín
authors.initials: B
authors.lastname: Oller-Sales
authors.forename: José
authors.initials: J
authors.lastname: Troya-Díaz
authors.forename: M Jesús
authors.initials: MJ
authors.lastname: Martinez-Arconada
authors.forename: Nivardo
authors.initials: N
authors.lastname: Rodriguez
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Pachá-González
authors.forename: Josep
authors.initials: J
authors.lastname: Roca
authors.forename: Jorge
authors.initials: J
authors.lastname: Carrillo
authors.forename: Joaquim
authors.initials: J
authors.lastname: Riba-Jofré
authors.forename: M José
authors.initials: MJ
authors.lastname: Rodrigo
authors.forename: Evarist
authors.initials: E
authors.lastname: Feliu
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pujol-Borrell
authors.forename: Eva
authors.initials: E
authors.lastname: Martínez-Cáceres
mesh_terms: D000293:Adolescent; D000328:Adult; D000907:Antibodies, Bacterial / Q000097:blood; D005260:Female; D006193:Haemophilus influenzae / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D008875:Middle Aged; D013154:Spleen / Q000276:immunology* / Q000293:injuries*; D013156:Splenectomy; D013296:Streptococcus pneumoniae / Q000276:immunology; D014611:Vaccination
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M