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Post-Splenectomy Management — RACP Adult Medicine MCQ

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EasyInfectious DiseasesPost-Splenectomy ManagementRACP Adult Medicine

A 30-year-old man underwent emergency splenectomy after a motor vehicle accident 5 years ago. He presents with malaise and a blood film showing Howell-Jolly bodies, target cells, and acanthocytes. His platelet count is 550 × 10⁹/L. He is not on any prophylactic medications and was not vaccinated post-splenectomy. What is the single most important intervention?

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Correct answer: A — Commence prophylactic amoxicillin

Post-splenectomy patients are at lifelong risk of overwhelming post-splenectomy infection (OPSI) from encapsulated organisms. The most important interventions are: (1) vaccination (pneumococcal, meningococcal, Hib — should have been given perioperatively), (2) prophylactic antibiotics (amoxicillin 250 mg daily — recommended lifelong or at minimum for 2 years post-splenectomy), and (3) patient education (early self-treatment for febrile illness). Howell-Jolly bodies confirm functional asplenia.

Reference: Spleen Australia – 2024; ATAGI 2024; eTG Antibiotic 2025