To the Editor.–Dr Dickerman's article on the risks of overwhelming postsplenectomy sepsis after splenectomy for trauma (Archives 1981;116:361-363) strongly suggests that this problem is grossly underreported and often is not recognized. I wish to add to his 34 case reports another by Cairns and Say.1
The major immune defect after splenectomy is the body's inability to mount an immune response rapidly to a new particulate antigen. It is still not certain whether this is due to a lack of tuftsin (as suggested by Constantopoulos and his group from Tufts University) or whether some further mechanism remains to be elucidated. Certainly the cases of fatal overwhelming postsplenectomy sepsis that have occurred despite relatively large masses of splenotic tissue suggest that the splenic autograft possesses an immune function that is less effective than its phagocytic abilities.
Dr Baue, in his editorial comment, raised the problem of underreporting. The vast majority