Are asplenic patients at increased risk for acquiring COVID 19 or complications related to COVID 19?

Posted on May 2, 2020 by Madalon Burnett

Summary

There is no direct evidence to suggest that asplenic patients are at higher or lower risk during the COVID-19 pandemic. There is a really excellent article here that explains what we do know about asplenia and COVID-19 to patients https://www.health.harvard.edu/blog/no-spleen-what-you-need-to-know-to-stay-healthy-2020042419641. Not all cases of asplenia are equal, and special precautions should be taken for patients with some diseases such as homozygous sickle cell anemia. 

Asplenia and infection

  • Functional and anatomical asplenia is associated with an increased rate of infection, especially by encapsulated bacteria (1).
  • Those who undergo splenectomy for trauma-related reasons are less susceptible to infections than those that undergo splenectomy for hematologic or oncologic reasons (1).
  • Life-threatening infections in asplenic patients are called overwhelming postsplenectomy infections (OPSI). OPSI tends to be caused by encapsulated bacteria (H influenae, N meningitis, etc.) or protozoa. OPSI is not typically caused by viral agents in the absence of an underlying malignancy (2). 

I.   Asplenia and infection

  • Functional and anatomical asplenia is associated with an increased rate of infection, especially by encapsulated bacteria (1).
  • Those who undergo splenectomy for trauma-related reasons are less susceptible to infections than those that undergo splenectomy for hematologic or oncologic reasons (1).
  • Life-threatening infections in asplenic patients are called overwhelming postsplenectomy infections (OPSI). OPSI tends to be caused by encapsulated bacteria (H influenae, N meningitis, etc.) or protozoa. OPSI is not typically caused by viral agents in the absence of an underlying malignancy (2).

II.   COVID-19 and asplenia

  • Harvard Health Blog gives this information (3): 
    • “At this point, we do not know for sure how lacking a spleen might affect a person’s ability to fight COVID-19. For most viruses, not having a spleen does not seem to be a major risk factor for illness.
    • So far this seems to be true for COVID-19 as well. New studies are being published constantly, but lack of a spleen has not been identified as a risk factor for acquiring COVID-19 or having worse outcomes. This is likely because the other lymphoid tissues in the body are able to produce an adequate response. However, it is likely that a person’s ability to fight any infection is at least a little diminished compared to what it would be if they did have a spleen. So with an infection like COVID-19 that can be severe and deadly even in healthy individuals, anyone without a spleen should be extra vigilant in following CDC recommendations to protect themselves and others”.
  • The platelet disorder support association recommends (4): “ITP (immune thrombocytopenic purpura) patients who have had a splenectomy are not predisposed to getting the COVID-19 virus. However, they might have trouble handling certain bacterial infections which might happen as a complication after a COVID-19 infection. That is why patients without spleens are encouraged to make sure they are up to date with their three vaccines: H influenzae (this is not the flu vaccine), Pneumococcus, and N meningitis.”

The platelet disorder support association recommends (4): “ITP (immune thrombocytopenic purpura) patients who have had a splenectomy are not predisposed to getting the COVID-19 virus. However, they might have trouble handling certain bacterial infections which might happen as a complication after a COVID-19 infection. That is why patients without spleens are encouraged to make sure they are up to date with their three vaccines: H influenzae (this is not the flu vaccine), Pneumococcus, and N meningitis.”

 

  • The CDC provides information for several high-risk groups about precautions during the COVID-19 pandemic. Asplenia is not addressed, but the following information relates to patients that are immunocompromised (5). 
    • People who are immunocompromised: Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications”.
    • “People with a weakened immune system have reduced ability to fight infectious diseases, including viruses like COVID-19. Knowledge is limited about the virus that causes COVID-19, but based on similar viruses, there is concern that immunocompromised patients may remain infectious for longer than other COVID-19 patients”.
  • The CDC recommends the following for people that are at higher risk for severe illness (5): 
    • “Continue your medications and do not change your treatment plan without talking to your doctor.
    • Have at least a 2-week supply of prescription and non-prescription medications. Talk to your healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.
    • Talk to your healthcare provider about whether your vaccinations are up-to-date. People older than 65 years, and those with many underlying conditions, such as those who are immunocompromised or with significant liver disease, are recommended to receive vaccinations against influenza and pneumococcal disease.
    • Do not delay getting emergency care for your underlying condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care for your underlying condition.
    • Ca                                        bbf functional asplenia.

Their recommendations for people who fall under the list of extremely vulnerable to COVID-19 are (6):

    • You’re strongly advised to stay at home at all times and avoid any face-to-face contact if you’re clinically extremely vulnerable to protect yourself. This is called ‘shielding’.
    • Shielding means:
  1. Do not leave your house.
  2. Do not attend any gatherings. This includes gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
  3. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.

III.   Guidelines about high risk groups during the COVID-19 pandemic

  • The CDC provides information for several high-risk groups about precautions during the COVID-19 pandemic. Asplenia is not addressed, but the following information relates to patients that are immunocompromised (5). 
    • People who are immunocompromised: Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications”.
    • “People with a weakened immune system have reduced ability to fight infectious diseases, including viruses like COVID-19. Knowledge is limited about the virus that causes COVID-19, but based on similar viruses, there is concern that immunocompromised patients may remain infectious for longer than other COVID-19 patients”.
  • The CDC recommends the following for people that are at higher risk for severe illness (5): 
    • “Continue your medications and do not change your treatment plan without talking to your doctor.
    • Have at least a 2-week supply of prescription and non-prescription medications. Talk to your healthcare provider, insurer, and pharmacist about getting an extra supply (i.e., more than two weeks) of prescription medications, if possible, to reduce trips to the pharmacy.
    • Talk to your healthcare provider about whether your vaccinations are up-to-date. People older than 65 years, and those with many underlying conditions, such as those who are immunocompromised or with significant liver disease, are recommended to receive vaccinations against influenza and pneumococcal disease.
    • Do not delay getting emergency care for your underlying condition because of COVID-19. Emergency departments have contingency infection prevention plans to protect you from getting COVID-19 if you need care for your underlying condition.
    • Call your healthcare provider if you have any concerns about your underlying medical conditions or if you get sick and think that you may have COVID-19. If you need emergency help, call 911.”
  • The public health agency of England lists people with the following conditions as extremely vulnerable to COVID-19 (6). The list does not include asplenia, but does include homogenous sickle cell disease, which can be a cause of functional asplenia.

Their recommendations for people who fall under the list of extremely vulnerable to COVID-19 are (6):

    • You’re strongly advised to stay at home at all times and avoid any face-to-face contact if you’re clinically extremely vulnerable to protect yourself. This is called ‘shielding’.
    • Shielding means:
  1. Do not leave your house.
  2. Do not attend any gatherings. This includes gatherings of friends and families in private spaces, for example, family homes, weddings and religious services.
  3. Strictly avoid contact with someone who is displaying symptoms of coronavirus (COVID-19). These symptoms include high temperature and/or new and continuous cough.va

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. The Asplenic Patient: Post-Insult Immunocompetence, Infection, and Vaccination | Surgical Infections [Internet]. Surgical Infections. 2017 [cited 2020 May 2]. Available from: https://www.liebertpub.com/doi/abs/10.1089/sur.2016.267?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=sur
  2. Fever in a Splenectomized Patient – Infectious Disease and Antimicrobial Agents [Internet]. Antimicrobe.org. 2010 [cited 2020 May 2]. Available from: http://www.antimicrobe.org/e30.asp
  3. Merchant E. No spleen? What you need to know to stay healthy – Harvard Health Blog [Internet]. Harvard Health Blog. 2020 [cited 2020 May 1]. Available from: https://www.health.harvard.edu/blog/no-spleen-what-you-need-to-know-to-stay-healthy-2020042419641
  4. Platelet Disorder Support Association – for People with ITP – Coronavirus (COVID-19) [Internet]. Pdsa.org. 2020 [cited 2020 May 1]. Available from: https://www.pdsa.org/covid-19.html
  5. CDC. People Who Are at Higher Risk for Severe Illness [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 May 2]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html#immunocompromised
  6. Public Health England. Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 [Internet]. GOV.UK. GOV.UK; 2020 [cited 2020 May 2]. Available from: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.