pneumococcal vaccination two weeks prior to elective splenectomy, but provide no recommendation for those undergoing emergent splenectomy3. We have shown in previous studies that vaccination with pneumococcal polysaccharide vaccine 14 days after splenectomy for trauma elicits the best antibody response.4,5 However, no human studies have ever been published examining the immunologic status of patients following embolization or nonoperative management of their spleens following traumatic disruption. The unknown factor in splenic embolization is the degree of retained immunologic function and is probably primarily a function of the quantity of viable spleen remaining following embolization. Though embolization is a demonstrated valuable adjunct in splenic salvage6, if no, or inadequate, residual immune function remains, the value of embolization is not only questionable, but these patients must then be treated as any other asplenic patient, i.e., they must also be vaccinated and made aware of their life-long risk of OPSS. Van Wyck7,8 has demonstrated that splenic mass (in the animal model) does indeed dictate the ability of the spleen to impart a humoral response to pneumococcal antigen, demonstrating that at least one-third of the normal splenic mass provides a clear-cut protective edge over asplenia. The experimental animal model, however, used graded partial splenic amputation, preserving the native anatomy and blood supply, rendering this model of questionable value to answer the question posed in the current study. Inclusion and Exclusion Criteria Inclusion: Adult trauma patients aged 18 to 65 years old, sustaining a splenic injury and undergoing splenectomy or splenic artery embolization are eligible for enrollment in the study. Exclusion: Prisoners The management decision for the splenic injury is entirely at the discretion of the attending trauma surgeon and radiologist (in the case of splenic artery embolization). All patients undergoing one of the treatment approaches under study will be brought to the attention of the Principal Investigator at the respective institutions. These patients will then be offered participation in the study.
pneumococcal vaccination two weeks prior to elective splenectomy, but provide no recommendation for those undergoing emergent splenectomy3. We have shown in previous studies that vaccination with pneumococcal polysaccharide vaccine 14 days after splenectomy for trauma elicits the best antibody response.4,5 However, no human studies have ever been published examining the immunologic status of patients following embolization or nonoperative management of their spleens following traumatic disruption. The unknown factor in splenic embolization is the degree of retained immunologic function and is probably primarily a function of the quantity of viable spleen remaining following embolization. Though embolization is a demonstrated valuable adjunct in splenic salvage6, if no, or inadequate, residual immune function remains, the value of embolization is not only questionable, but these patients must then be treated as any other asplenic patient, i.e., they must also be vaccinated and made aware of their life-long risk of OPSS. Van Wyck7,8 has demonstrated that splenic mass (in the animal model) does indeed dictate the ability of the spleen to impart a humoral response to pneumococcal antigen, demonstrating that at least one-third of the normal splenic mass provides a clear-cut protective edge over asplenia. The experimental animal model, however, used graded partial splenic amputation, preserving the native anatomy and blood supply, rendering this model of questionable value to answer the question posed in the current study. Inclusion and Exclusion Criteria Inclusion: Adult trauma patients aged 18 to 65 years old, sustaining a splenic injury and undergoing splenectomy or splenic artery embolization are eligible for enrollment in the study. Exclusion: Prisoners The management decision for the splenic injury is entirely at the discretion of the attending trauma surgeon and radiologist (in the case of splenic artery embolization). All patients undergoing one of the treatment approaches under study will be brought to the attention of the Principal Investigator at the respective institutions. These patients will then be offered participation in the study.