A young patient reports that her SPLEEN was surgically removed some years ago. Which underlying condition does this most suggest?

Correct answer: C. Sickle cell disease

• A. Hypothyroidism has no relationship to splenic surgery.
• B. Diabetes has no association with splenectomy.
• C. CORRECT. SICKLE CELL DISEASE is a leading reason for splenectomy in a young patient. Repeated splenic sequestration crises and infarction cause autosplenectomy or necessitate surgical removal. Other classic indications are hereditary spherocytosis, thalassaemia, immune thrombocytopenia and traumatic rupture.
• D. Felty syndrome (rheumatoid arthritis with splenomegaly and neutropenia) rarely leads to splenectomy, but it is a far less likely explanation in a young patient than a haemoglobinopathy.

Note: The dental implication of asplenia is immediate: these patients are at lifelong risk of overwhelming sepsis from ENCAPSULATED organisms (pneumococcus, meningococcus, Haemophilus influenzae type b). They should be vaccinated against all three, and antibiotic prophylaxis before invasive procedures warrants discussion with their physician.