Which of the following statements regarding post splenectomy sepsis are true?

a. The incidence in children is generally reported as less than 5%

b. Haemophilus influenzae, Streptococcus pneumoniae and Neiseria meningitidis are the most common causative organisms

d. The mortality rate is now approximately 50%

e. The incidence in adults in approximately 1%

Postsplenectomy sepsis (PSS) refers to the increased risk of systemic infection in patients who have undergone splenectomy. The incidence of PSS in children is as high as 4% during a follow-up of nearly 10 years, and from 0.3% to 1.8% in adults during an 8-year follow-up. The highest incidence of PSS is among those who have undergone splenectomy for associated malignancies or who had an incidental splenectomy during other surgical procedures in adulthood. In children, the patients most at risk for PSS are those who have undergone splenectomy for either congenital or acquired anemias. It is important to remember that any patient who has undergone splenectomy or who has hyposplenism is at risk for PSS.

The most common causative organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Neiseria meningitidis. Other less common encapsulated organisms have also been identified. In addition, organisms without classical polysaccharide cell walls can occasionally produce overwhelming infection in postsplenectomy patients. The mortality from PSS is approximately 50%. Splenic autotransplantation has been proposed as an alternative means of splenic preservation in patients whose spleens are too severely injured for in situ repair. Splenic autotransplants do not appear to have normal splenic function. Splenic autotransplants have diminished ability to protect against PSS when compared to a normal spleen and they have not been demonstrated to prevent post-splenectomy sepsis.