Immunologische functie van de milt na embolisatie bij traumapatiënten


Na traumatisch miltletsel wordt naast operatie steeds vaker gekozen voor (a)selectieve coiling. Het vermoeden bestaat dat de immunologische functie van de milt daarmee gehandhaafd blijft, maar bewezen is dat nog niet. Voor de dagelijkse praktijk is het noodzakelijk een gemakkelijk te meten parameter te vinden om snel de resterende miltfunctie te kunnen bepalen. Dit om een weloverwogen keuze te kunnen maken voor eventuele vaccinaties en/of antibioticaprofylaxe om eenoverwhelming postsplenectomie infection (OPSI) te voorkomen. Voor deze review doorzochten we verschillende databases naar studies over de immunologische functie van de milt na embolisatie. Zeven studies werden gevonden. Veelal zijn de auteurs het erover eens dat de immunologische functie mogelijk gehandhaafd blijft, maar over een methode om dit objectief vast te stellen, is geen overeenstemming. Verder onderzoek is noodzakelijk om een betrouwbare en eenvoudige parameter te vinden voor het meten van de overgebleven miltfunctie na embolisatie.


Splenic artery embolization, proximal or distal, is rapidly becoming the standard of care for traumatic splenic injury. Theoretically the immunological function of the spleen may be preserved, but this has not yet been proven. A parameter for measuring the remaining splenic function must therefore be determined to choose any vaccinations and/or antibiotic prophylaxis to prevent an overwhelming postsplenectomy infection (OPSI).

For this review, we searched several databases for studies on the immunological function of the spleen after embolization. Seven studies were found. Although most of the authors agree that the immunological function is preserved, there is still no consensus on how to prove this. Further research is necessary to find a parameter for measuring the residual splenic function after embolization.

This is a preview of subscription content, access via your institution.


  1. 1.

    Kiwa/Prismant Kennis- en expertisecentrum voor de zorg 2009.

  2. 2.

    King H, Schumacher HB Jr. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952;136:239–42.

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma. 2000;49:177–87.

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Sclafani S, Shaftan G, Scalea T, et al. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma. 1995;39:818–25.

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Haan J, Biffl W, Knudson M, et al. Splenic embolization revisited: a multicenter review. J Trauma. 2004;56:542–7.

    PubMed  Article  Google Scholar 

  6. 6.

    Moore E, Cogbill T, Jurkovich G, et al. Organ injury scaling: spleen and liver (1994 revision). J Trauma. 1995;38:323–4.

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Bessoud B, Denys A, Calmes J, et al. Nonoperative management of traumatic splenic injuries in adult patients: is there a role for proximal splenic artery embolization? AJR Am J Roentgenol. 2006;186:779–85.

    PubMed  Article  Google Scholar 

  8. 8.

    Brigden ML, Pattullo A, Brown G. Pneumococcal vaccine administration associated with splenectomy: the need for improved education, documentation, and the use of a practical checklist. Am J Hematol. 2000;65:25–9.

    PubMed  Article  CAS  Google Scholar 

  9. 9.

    Cullingford GL, Watkins DN, Watts AD, Mallon DF. Severe late postsplenectomy infection. Br J Surg. 1991;78:716–21.

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Styrt B. Infection associated with asplenia: risks, mechanisms, and prevention. Am J Med. 1990;88:33N–42N.

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Lutwick LI. Infections in asplenic patients. In: Mandell GJ, Bennett JE, Raphael D, eds. Principles and practice of infectious diseases, 7th ed. Churchill Livingstone, Elsevier, 2010. p. 3865–73.

    Google Scholar 

  12. 12.

    Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg. 1991;78:1031–8.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    De Porto AP, Lammers AJ, Bennink RJ, et al. Assessment of splenic function. Eur J Clin Microbiol Infect Dis. 2010;29:1465–73.

    PubMed  Article  Google Scholar 

  14. 14.

    Davies JM, Barnes R, Milligan D. Update of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Clin Med. 2002;2:440–3.

    PubMed  CAS  Google Scholar 

  15. 15.

    Mourtzoukou EG, Pappas G, Peppas G, Falagas ME. Vaccination of asplenic or hyposplenic adults. Br J Surg. 2008;95:273–80.

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Zhou W, Pool V, Iskander JK, et al. Surveillance for safety after immunization: Vaccine Adverse Event Reporting System (VAERS) – United States, 1991–2001. MMWR Surveill Summ. 2003;52:1–24.

    PubMed  Google Scholar 

  17. 17.

    Bessoud B, Duchosal MA, Siegrist CA, et al. Proximal splenic artery embolization for blunt splenic injury: clinical, immunologic, and ultrasound-Doppler follow-up. J Trauma. 2007;62:1481–6.

    PubMed  Article  Google Scholar 

  18. 18.

    Walusimbi MS, Dominguez KM, Tran EP, et al. Immunologic integrity after splenic embolization for trauma (abstract). Presented at the American Association for the Surgery of Trauma 66th Annual Meeting, 2007.

  19. 19.

    Falimirski M, Syed A, Prybilla D. Immunocompetence of the severely injured spleen verified by differential interference contrast microscopy: the red blood cell pit test. J Trauma. 2007;63:1087–92.

    PubMed  Article  Google Scholar 

  20. 20.

    Casper JT, Koethe S, Rodey GE, et al. A new method for studying splenic reticuloendothelial dysfunction in sickle cell disease patients and its clinical application: a brief report. Blood. 1976;47:183–8.

    PubMed  CAS  Google Scholar 

  21. 21.

    Nakae H, Shimazu T, Miyauchi H, et al. Does splenic preservation treatment (embolization, splenorrhaphy, and partial splenectomy) improve immunologic function and long-term prognosis after splenic injury? J Trauma. 2009;67:557–63.

    PubMed  Article  Google Scholar 

  22. 22.

    Tominaga GT, Simon FJ Jr, Dandan IS, et al. Immunologic function after splenic embolization, is there a difference? J Trauma. 2009;67:289–95.

    PubMed  Article  Google Scholar 

  23. 23.

    Prasopoulos P, Daskalogiannaki M, et al. Determination of normal splenic volume on computed tomography in relation to age, gender and body habitus. Eur Radiol. 1997;7:246–8.

    Article  Google Scholar 

  24. 24.

    Malhotra AK, Carter RF, Lebman DA, et al. Preservation of splenic immunocompetence after splenic artery angioembolization for blunt splenic injury. J Trauma. 2010;69:1126–30.

    PubMed  Article  Google Scholar 

  25. 25.

    Wolf HM, Eibl MM, Georgi E, et al. Long-term decrease of CD4+CD45RA+ T cells and impaired primary immune response after post-traumatic splenectomy. Br J Haematol. 1999;107:55–68.

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Shih HC, Wang CY, Wen YS, et al. Spleen artery embolization aggravates endotoxin hyporesponse of peripheral blood mononuclear cells in patients with spleen injury. J Trauma. 2010;68:532–7.

    PubMed  Article  Google Scholar 

  27. 27.

    Majetschak M, Flach R, Heukamp T, et al. Regulation of whole blood tumor necrosis factor production upon endotoxin stimulation after severe blunt trauma. J Trauma. 1997;43:880–7.

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Baeuerle PA, Henkel T. Function and activation of NF-κB in the immune system. Annu Rev Immunol. 1994;12:141–79.

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Shatz DV. Vaccination practices among North American trauma surgeons in splenectomy for trauma. J Trauma. 2002;53:950–6.

    PubMed  Article  Google Scholar 

  30. 30.

    Corazza GR, Ginaldi L, Zoli G, et al. Howell-Jolly body counting as a measure of splenic function. A reassessment. Clin Lab Haematol. 1990;12:269–75.

    PubMed  Article  CAS  Google Scholar 

  31. 31.

    Harrod VL, Howard TA, Zimmerman SA, et al. Quantitative analysis of Howell-Jolly bodies in children with sickle cell disease. Exp Hematol. 2007;35:179–83.

    PubMed  Article  Google Scholar 

  32. 32.

    Holroyde CP, Oski FA, Gardner FH. The ‘pocked’ erythrocyte. Red-cell surface alterations in eticuloendothelial immaturity of the neonate. N Engl J Med. 1969;281:516–20.

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Corazza GR, Bullen AW, Hall R, et al. Simple method of assessing splenic function in coeliac disease. Clin Sci (Lond). 1981;60:109–13.

    CAS  Google Scholar 

  34. 34.

    Corazza GR, Tarozzi C, Vaira D, et al. Return of splenic function after splenectomy: how much tissue is needed? Br Med J (Clin Res Ed). 1984;289:861–4.

    Article  CAS  Google Scholar 

  35. 35.

    Kruetzmann S, Rosado MM, Weber H, et al. Human immunoglobulin M memory B cells controllingStreptococcus pneumoniae infections are generated in the spleen. J Exp Med. 2003;197:939–45.

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Di Sabatino A, Rosado MM, Ciccocioppo R, et al. Depletion of immunoglobulin M memory B cells is associated with splenic hypofunction in inflammatory bowel disease. Am J Gastroenterol. 2005;100:1788–95.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information



Additional information

student geneeskunde



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Schimmer, J., van der Steeg, A. & Zuidema, W. Immunologische functie van de milt na embolisatie bij traumapatiënten. TIJD. TRAUMATOLOGIE 20, 74–79 (2012).

Download citation