Survivorship: Health Concerns After Splenectomy

What is the spleen?

The spleen is an organ found in the upper part of the abdomen (belly) that works like a filter, removing bacteria and dead red blood cells from the bloodstream. In some cancers, the spleen may be removed or treated with radiation, leaving it unable to function. This condition is called “asplenia” and it plays a role in the health and care of affected survivors.

What happens after a splenectomy?

Removal of the spleen (or radiation to the spleen) results in a survivor being at higher risk for infections caused by certain types of bacteria. Streptococcus pneumoniae and Haemophilus influenzae type b are the most common infections after a splenectomy. An infection can quickly lead to sepsis, which is a life-threatening reaction throughout your body. Sepsis can lead to death if not treated quickly with antibiotics. Some experts think survivors with asplenia should have antibiotics on hand to start at the first sign of infection, even before being seen by the healthcare team. Talk with your provider to see if this is the case for you.

Splenectomy survivors must know the importance of:

• Reporting a fever (temperature greater than 100.4°F [38°C]) or any sign of infection (listed below) to their healthcare team right away, or to go to an emergency room.
• Telling any healthcare provider caring for them that they do not have a working spleen.
• Wearing a medic-alert bracelet noting this condition ("asplenia")
• Receiving annual influenza (flu) vaccines, as well as the pneumococcal and Hepatitis B vaccines.
• Receiving the meningococcal and H. influenzae type b vaccines (this is not the same as the annual flu vaccine),
• If bitten by a dog, cat, or rodent, antibiotics are required to prevent infection with Capnocytophaga canimorsus bacteria.
• If traveling to or living in an area with malaria, taking medication to prevent infection with malaria and using mosquito repellent.
• If you are traveling to or living near Cape Cod or Nantucket Island in Massachusetts, Southern New England, and the Hudson Valley in New York, you may be more likely to have issues from an infection called Babesia caused by deer ticks. If you notice you have been bitten by a tick, please contact your healthcare provider as soon as possible as this species of tick may transmit Lyme disease.

Key Takeaways

Survivors who have asplenia should:

• Wear a medic alert bracelet noting asplenia (no functioning spleen).
• Notify your healthcare team right away if you develop a temperature greater than 100.4°F (38°C) or any signs of infection (sore throat, cough, burning with urination, ear pain, rash, or shortness of breath).
• Receive annual flu vaccine as well as pneumococcal, Haemophilus influenza type b (HIb), meningococcal, and hepatitis vaccines (per CDC guidelines). Speak with your provider about the need for other vaccines including Tdap, zoster, HPV, MMR, and varicella.
• When traveling outside the U.S., check for a need for additional vaccines or antibiotics.
• See your healthcare provider for any tick or animal bites.

Further Reading

The Centers for Disease Control: Asplenia & Adult Vaccination

Patient.co.uk: Preventing Infection after Splenectomy or if you do not have a Working Spleen.

UpToDate Patient Information: Preventing severe infection after splenectomy.