Splenectomy
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Patients with absent or non-functioning spleen
A non-functioning spleen may be due to blood dyscrasia, coeliac disease, inflammatory bowel disease, bone marrow or stem cell transplant, dermatitis herpetiformis or may be congenital.
Patients with absent or non-functioning spleen are at increased risk of overwhelming infection, particularly with Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitides, influenza, and malaria in travellers.
General Management
Check immunisation history with patient, administer vaccinations appropriately (see below for link to the Green Book) and inform patient's GP.
Table 1: Vaccination schedules for splenectomy patients
Procedure |
Time schedule for vaccinations |
Elective splenectomy |
Where possible, vaccination course should ideally be started at least 2 weeks before surgery or start of immunosuppressive treatment. |
Emergency splenectomy |
2 weeks post-operatively (functional antibody response may be better with delayed vaccination) |
Completion of radio- or chemotherapy |
Delay vaccination for at least 3 months. |
Vaccinations
See Chapter 7 of the Green Book:
Long-term antibiotic prophylaxis
All patients with an absent or dysfunctional spleen should receive prophylactic antibiotics for at least 2 years, but ideally for life. Prophylactic antibiotics should be started immediately post surgery.
Phenoxymethylpenicillin (Penicillin V) oral 250mg twice daily
If true penicillin / beta-lactam allergy:
Erythromycin oral 500 mg every twice daily
The NHS Health Scotland 'A guide for people without a working spleen' can be accessed
here: www.healthscotland.com/documents/25070.aspx
Bibliography:
- The Green Book, chapter 7 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/857279/Greenbook_chapter_7_Immunsing_immunosupressed.pdf
(Accessed 23rd June 2021)
- https://www.nhsinform.scot/healthy-living/immunisation/when-to-immunise/children-and-adults-without-a-spleen-asplenia (Accessed 23rd June 2021)
- British Society for Haematology: Review of Guidelines for the Prevention and Treatment of Infection in Patients with an Absent or Dysfunctional Spleen http://www.b-s-h.org.uk/guidelines/archived-guidelines/ accessed 07/07/17.
- Guidelines for the prevention of infection in patients with an absent or dysfunctional spleen, NHS Ayrshire and Arran Infection Prevention and Control Team, Section 16, Issue no 4 October 2011.