MBBS OSCE · Haematology
OSCE — Asplenia and Post-Splenectomy Care
Eight-minute OSCE station on Asplenia and Post-Splenectomy Care: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Asplenia and Post-Splenectomy Care.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Asplenia (surgical, congenital, or functional from sickle cell) predisposes to overwhelming post-splenectomy infection (OPSI) from encapsulated organisms (Strep pneumoniae, Neisseria meningitidis, Haemophilus influenzae). Management: vaccination (PCV13, PPSV23, MenACWY, MenB, Hib) at least 2 weeks before elective splenectomy or 2 weeks after emergency; lifelong daily antibiotic prophylaxis (phenoxymethylpenicillin 250 to 500 mg BD, or amoxicillin); patient education and alert card; prompt empirical antibiotics for fever (ceftriaxone 2 g IV/IM).
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Fever in an asplenic patient = OPSI until proven otherwise - empirical ceftriaxo |
| Safety | Purpura fulminans (rapidly spreading purpura + shock + DIC) in an asplenic patie |
| Safety | Patient with splenectomy and severe sepsis from Capnocytophaga canimorsus after |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.