Survivorship: Health Concerns After Splenectomy

What is the spleen?

The spleen is an organ in the upper left part of your abdomen (belly). It filters your blood, removing bacteria and old red blood cells. It also helps your immune system fight infection.

In some cancers, the spleen is removed (a splenectomy) or treated with radiation. Both can leave you without a spleen that works the way it should. This is called “asplenia.”

What happens after a splenectomy?

Removal of the spleen (or radiation to the spleen) puts you 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 become sepsis, which is a life-threatening reaction in your body, very quickly. Sepsis is a life-threatening reaction to an infection. Your provider may give you a prescription for antibiotics to keep at home, but still be sure to call them if you have symptoms of infection.

If you had a splenectomy, you should:

• Call your provider right away, or go to an emergency room, if you have a fever of 100.4°F (38°C) or higher, or any sign of infection. This includes chills, sore throat, cough, burning when you urinate, ear pain, rash, shortness of breath, severe headache, stiff neck, vomiting, or confusion. Do not wait to see if it gets better, even if you feel only a little sick.
• Tell every provider caring for you that you do not have a working spleen.
• Wear a medic-alert bracelet stating that you do not have a functioning spleen ("asplenia").
• Get an annual influenza (flu) vaccine and COVID vaccine, as well as the pneumococcal and Hepatitis B vaccines.
• Get the meningococcal and H. influenzae type b vaccines (this is not the same as the annual flu vaccine).
• Animal bites: If a dog, cat, or rodent bites or scratches you, wash the wound and call your provider right away, even if it looks small. You may need antibiotics to prevent infection with Capnocytophaga canimorsus bacteria.
• Malaria prevention: If you travel to or live in an area with malaria, talk to your provider or a travel clinic first. You will likely need medicine to prevent malaria, and you should use mosquito repellent.
• Ticks: Babesiosis is an infection spread by deer ticks. It is more common in parts of the Northeast and upper Midwest, such as Cape Cod, Nantucket, southern New England, and the Hudson Valley in New York. It can be more serious if you do not have a spleen. Use tick protection, check yourself for ticks, and call your provider right away if you are bitten or become ill after being outdoors. 

Further Reading

The Centers for Disease Control: What Vaccines are Recommended for You. 

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

UpToDate Patient Information: Preventing severe infection after splenectomy.