Survivorship: Health Concerns After Splenectomy
The spleen is an organ located in the upper abdomen that functions somewhat like a filter, removing bacteria and dead red blood cells from the blood stream. In some cancers, the spleen may be removed or treated with radiation, leaving it unable to function. This condition is called asplenia and it has some important implications for the health and care of affected survivors.
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, with Streptococcus pneumoniae and Haemophilus influenzae type b being the most common. An infection can quickly progress to sepsis and can lead to death if not treated quickly with antibiotics. Some experts believe survivors with asplenia should have antibiotics on hand to be started at the first sign of infection, even before being evaluated by the healthcare team. These survivors must be aware of the importance of reporting a fever (temperature > 100.4°F (38°C)) or any sign of infection to their healthcare team right away, or to go to an emergency room for evaluation if their doctor is not available. They must be sure to let any healthcare provider caring for them know that they do not have a functioning spleen.
Survivors should wear a medic-alert bracelet noting this condition ("asplenia") and should receive annual influenza vaccines, as well as the pneumococcal and Hepatitis B vaccines. They should also receive the meningococcal and H. influenzae type b vaccines (this is not the same as the annual flu vaccine), and if bitten by a dog, cat or rodent, antibiotics are required to prevent infection with Capnocytophaga canimorsus bacteria.
If traveling to an area with malaria, taking medication to prevent infection with malaria and the use of a mosquito repellent are important. If traveling to or living in Cape Cod or Nantucket Island in Massachusetts, you may be more likely to have complications from an infection caused by deer ticks called Babesia. 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.
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, haemophilis influenza type b (HIb), meningococcal and hepatitis vaccines (per CDC guidelines). Speak with your provider regarding the need of other vaccines including Tdap, zoster, HPV, MMR, and varicella.
- When traveling outside the U.S., evaluate need for additional vaccines or antibiotics.
- See your healthcare provider for any tick or animal bites.
The Centers for Disease Control: Asplenia & Adult Vaccination
UpToDate Patient Information: Preventing severe infection after splenectomy.