CASE 45
Mary, a 3-year-old girl, had her spleen removed after a motor vehicle accident, in which both parents died. When she was transferred to the emergency department of a nearby hospital, it became apparent that her spleen had ruptured and the surgeon had no option but to remove it. Mary recovered well from the surgery, but her next of kin, who knows that the spleen is important in immune responses, wants to know how removal of the spleen will affect her immunologically, and so you arrange for a consultation with an immunologist.
QUESTIONS FOR GROUP DISCUSSION
1. Mary has just received a splenectomy. What is the immunologic role of the spleen? To what types of infections will Mary be particularly susceptible?
2. Explain how a simple act such as brushing or flossing teeth could pose a problem for Mary now that her spleen has been removed.
3. Review the current recommended immunization schedule for the United States in 2005. See Figure 45-1.
4. Mary’s record showed that she had received most of the vaccines that were recommended. The immunologist recommended immunization with the polysaccharide pneumococcal vaccine (Pneumovax 23). Explain why.
5. What would you recommend as daily prophylaxis for this patient? Explain why. Discuss circumstances under which you would increase this drug regimen.
6. Asplenia in this patient was the result of surgery; however, asplenia can also be a congenital defect. Congenital asplenia has an autosomal recessive mode of inheritance. Explain this form of inheritance. Under what circumstances would offspring be at increased risk for autosomal recessive disorders.
8. What would you expect a complete blood cell count to reveal in patients with severe pneumococcal pneumonia? What would you expect a chest radiograph to indicate?
9. Respiratory infections can be lethal in the elderly and in splenic individuals. As such, an influenza vaccine would be recommended for Mary. What are the limitations of these vaccines?
