Initial evaluation for patients with impaired splenic function with fever and/or sepsis

Complete blood count with differential

Peripheral blood smear

Comprehensive metabolic panel (including liver function tests)

Coagulation studies (prothrombin time, partial thromboplastin time, D-dimer)

Serum lactate

Arterial blood gas (venous blood gas may be appropriate for children)*

Peripheral blood cultures (ideally drawn before antibiotics)

Urinalysis and urine culture

Chest radiograph

Lumbar puncture^¶

Quantitative immunoglobulins^Δ

In addition to a thorough history and physical examination, we generally include or consider these tests or procedures in our evaluation of patients with impaired splenic function and fever and/or sepsis.

* Depending on severity of illness.
¶ If meningitis suspected based on clinical features (eg, fever, headache, neck stiffness, altered mental status).
Δ Some UpToDate authors and editors send quantitative immunoglobulins (IgG level) to help determine the need for supplemental intravenous immune globulin (IVIG). Others do not favor the use of IVIG and do not send this test.

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Initial evaluation for patients with impaired splenic function with fever and/or sepsis