ABSITE - Spleen questions and answers with solutions 2025

A 29 year-
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old female with hereditary spherocytosis is recommended to undergo splenectomy. At what tim
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e point is trivalent immunization recommended?
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A. 1-month pre-op
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B. 2-weeks pre-op
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C. 1-week pre-op
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D. 1-week post-op
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E. 2-weeks post-op - ANSWER 2-weeks pre-op
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Correct.

Although rare, overwhelming post-splenectomy infection (OPSI) is a life-
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threatening complication that can occur weeks, months, or years following splenectomy. Encaps
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ulated organisms such as Haemophilus, Streptococcus pneumoniae, and Meningococcus are mo
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st commonly responsible. The Centers for Disease Control and Prevention recommends vaccinat
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ion against these three organisms 2 weeks prior to elective splenectomy.
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The risk of dying from overwhelming post-splenectomy infection (OPSI)
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A. is greatest after splenectomy for trauma.
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B. decreases as the interval after splenectomy increases.
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C. is greatest in the elderly.
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D. eventually becomes identical to the risk in the normal population.
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E. is eliminated by taking prophylactic penicillin. -
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ANSWER decreases as the interval after splenectomy increases.
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Correct.

An increased risk of sepsis and septic shock is directly related to splenectomy at any age. Childre
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n less than 15 years of age have a greater overall risk of developing overwhelming post-
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splenectomy infection (OPSI) compared with adults (0.13% to 8.1% versus 0.28% to 1.9%). Splen
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ectomized infants and young children are even more susceptible for pneumococcal sepsis.
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,The incidence of OPSI is related to the underlying disease. Historically the incidence of sepsis aft
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er splenectomy caused by trauma is lower than after splenectomy for hematologic disorders or
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malignancy. Increased mortality is also seen in patients with lymphoreticular disease, and in tho
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se undergoing extensive chemotherapy and radiation therapy.
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Published information indicates that most cases of OPSI present in the initial two years after spl
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enectomy, with 50% to 80% within this period. The mortality of OPSI is 50% or greater. The risk o
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f OPSI is lifelong, and OPSI has been reported more than 40 years after operation. Prophylactic p
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enicillin is of no proven benefit.
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You are consulted on a 55-year-
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old homeless woman admitted for sepsis with documented gram-
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positive bacteremia. A CT scan of the abdomen obtained today is shown below (multifocal absce
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sses). She has been started on broad-
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spectrum antibiotics. What is the most appropriate next step in her management?
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O




A. Mesenteric angiography and embolization
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B. Image-guided percutaneous drain placement
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C. Splenectomy
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D. Fine needle aspiration and culture of splenic lesions
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E. Administration of IgG - ANSWER Splenectomy
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Correct.

The image demonstrates multiple splenic abscesses likely seeded from the patient's bacteremia
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producing septic emboli. Optimal treatment is splenectomy. Image-
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guided drain placement may be an option for a marginally stable patient with a single abscess, b
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ut is prone to failure and complication. IgG is typically used in the treatment of ITP, not splenic a
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bscess. FNA and culture plays no role in the treatment of this disease process.
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An otherwise healthy 55-year-
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old female underwent a routine lipoma removal of the back. The procedure was completed with
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, out difficulty. Cefazolin was given as antibiotic prophylaxis. Twenty four hours post-
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op, the patient is noted to develop jaundice, fatigue, and splenomegaly. Direct Coombs' test is p
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ositive. What is the most likely diagnosis?
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A. Sickle cell anemia
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B. Splenic abscess
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C. Splenic vein thrombosis
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D. Immune thrombocytopenic purpura
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E. Autoimmune hemolytic anemia - ANSWER Autoimmune hemolytic anemia
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Correct.

Acquired autoimmune hemolytic anemia occurs due to the production of antibodies directed ag
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ainst RBC membrane proteins, and can either be idiopathic or secondary to infection or drugs (e
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.g. penicillin, hydralazine, quinidine). It typically presents in patients over the age of 50, with a hi
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gher incidence in females. Symptoms can include acute onset of jaundice, anemia, fevers, and s
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plenomegaly. A positive direct Coombs' test can confirm the diagnosis and differentiate from oth
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er forms of hemolytic anemia. Sickle cell anemia, splenic abscess, and splenic vein thrombosis d
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o not have positive direct Coombs' test, while the onset of ITP in adults is typically chronic.
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A 51-year-
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old male is diagnosed with chronic lymphocytic leukemia during workup of pancytopenia. He ha
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s required transfusions at least every other week for persistent pancytopenia that has not respo
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nded to chemotherapy. He complains of left-
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sided abdominal pain and his spleen is palpable 4 cm below the left costal margin. A CT is obtain
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ed (see below= splenomegaly). The next step in management should be
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A. Radiation therapy
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B. Splenic artery embolization
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C. IVIG O




D. Partial splenectomy
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E. Total splenectomy - ANSWER Total splenectomy
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Correct.