A physician-validated, board-style question from the Active Transport QBank. Try it, then check the reasoning for every option.
A 34-year-old woman is assaulted and suffers a number of stab wounds to her abdomen. Bystanders call paramedics and she is subsequently taken to the nearest hospital. On arrival to the emergency department, her vitals are T: 36 deg C, HR: 110 bpm, BP: 100/60, RR: 12, SaO2: 99%. A FAST and abdominal CT are promptly obtained which are demonstrated in Figures A and B, respectively. Her chart demonstrates no other medical problems and vaccinations/boosters up to date. The patient is diagnosed with a Grade V splenic laceration and is immediately brought to the OR for emergent splenectomy. The splenectomy is successfully performed with removal of the damaged spleen (Figure C). Following the operation, the patient should receive which of the following vaccines: (I) H. influenzae (II) Tetanus (III) N. meningitidis (IV) S. pneumoniae (V) Hepatitis B
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A
I, IIIncorrect. H. influenzae is needed for asplenia, but tetanus is part of routine vaccination, not specifically required after splenectomy; meningococcal and pneumococcal are missing.
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B
I, III, IVCorrect. Asplenia mandates vaccination against the three encapsulated organisms: H. influenzae type b, N. meningitidis, and S. pneumoniae.
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C
I, VIncorrect. Hepatitis B is unrelated to asplenia and is given as part of routine childhood/adult vaccination; this answer omits the critical meningococcal and pneumococcal vaccines.
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D
III, IVIncorrect. Meningococcal and pneumococcal are correct, but H. influenzae type b is also indicated and is omitted from this option.
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E
II, IV, VIncorrect. Tetanus and hepatitis B are routine adult vaccines unrelated to asplenia; this option omits the meningococcal vaccine, which is required along with H. influenzae and pneumococcal vaccines after splenectomy.
↑ Tap an answer to reveal the reasoning
Answer: B. Post-splenectomy patients are at lifelong risk for overwhelming post-splenectomy infection (OPSI) caused by encapsulated organisms, because the spleen is the principal filter for opsonized encapsulated bacteria. The three high-priority post-splenectomy vaccines therefore target the encapsulated organisms: Streptococcus pneumoniae (PCV13 and PPSV23), Haemophilus influenzae type b, and Neisseria meningitidis.
Ideally these vaccines are given at least 14 days before elective splenectomy. In emergent splenectomy (as in this trauma case), they are typically given 14 days post-operatively to allow optimal immune response. Patients also need lifelong awareness of fever as a medical emergency and may receive standby antibiotics.
Hepatitis B and tetanus are not specifically required because of splenectomy. Her chart notes 'vaccinations/boosters up to date,' so she has already received routine tetanus boosters and hepatitis B series. The question is asking which vaccines are uniquely needed because of asplenia.
**Why each option:**
**A.** H. influenzae is needed for asplenia, but tetanus is part of routine vaccination, not specifically required after splenectomy; meningococcal and pneumococcal are missing.
**B.** Correct. Asplenia mandates vaccination against the three encapsulated organisms: H. influenzae type b, N. meningitidis, and S. pneumoniae.
**C.** Hepatitis B is unrelated to asplenia and is given as part of routine childhood/adult vaccination; this answer omits the critical meningococcal and pneumococcal vaccines.
**D.** Meningococcal and pneumococcal are correct, but H. influenzae type b is also indicated and is omitted from this option.