Asplenia is the absence of the spleen or its function, which can be congenital or acquired. It makes people more vulnerable to infections, and preventive antibiotics are needed. Heterotaxy is a rare cause of congenital asplenia, with left atrial isomerism having small spleens that function, while right atrial isomerism has more severe heart defects and complete asplenia. People with asplenia need vaccinations and additional antibiotics for colds or flus, but overuse of antibiotics may lead to antibiotic resistance. Despite this, many people with asplenia have healthy lives.
“Asplenia” means absence of spleen or splenic function. This condition can be congenital or occur at birth, or it can occur later in life if the spleen somehow fails to function or if the spleen needs to be removed. The challenge of this situation at any point in life is that it makes people much more vulnerable to infection. To manage this problem, preventive antibiotics are usually needed and should be taken daily. There may also be a special protocol if the person with asplenia is exposed to serious illness or requires surgery.
Congenital asplenia is usually present with heart defects. Although rare, a condition called heterotaxy is a leading cause. Heterotaxy is further separated into right and left atrial isomerism. In left atrial isomerism, the body may have many small spleens, and these may function well enough to confer some immunity. Surgery is usually still needed in early childhood to repair conditions such as holes between the ventricles (ventricular septal defects) or narrowing of the pulmonary valve.
Right atrial isomerism is more severe, with more significant heart defects and complete asplenia. Heart defects associated with this condition include the atrioventricular canal, although others may be present. With both forms of heterotaxy the heart has coiled in the wrong direction during formation and is positioned abnormally. Other organs can also be disordered, besides the body lacking a spleen or having too many. It should be noted that asplenia can occasionally be congenital without heart defects.
There are a few reasons people might acquire asplenia. The most obvious is that the spleen needs to be removed at some point in life, either due to accident or trauma, or occasionally due to a treatment chosen to address certain blood disorders such as thalassemia. Some serious diseases can also destroy the spleen, and while it may be present, it may no longer function properly. An example of this is sickle cell disease, which can affect the spleen and ultimately cause its death.
The degree to which a missing spleen alone provides problems isn’t always possible to predict. In many cases people are doing quite well taking simple antibiotics such as amoxicillin every day. It is usually highly recommended that people with asplenia get vaccinations, although it may be inadvisable to use live active forms of vaccines. Doctors may also recommend additional antibiotics for use when colds or flus occur, and people with heterotaxy will especially need antibiotic prophylaxis before dental work.
The main concern with taking so many antibiotics is that they may cease to be effective and people could then get infections that are more difficult to treat. At the same time, the main treatment of asplenia is usually antibiotics, it is still important to use antibiotics wisely. It can be said, however, that many people with the condition have healthy lives and very few limitations on their behavior.
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