Splenectomy and Hyposplenism
⚠️ The spleen is essential for clearing encapsulated bacteria.
Loss of function → risk of overwhelming post-splenectomy infection (OPSI).
🦠 Most important pathogen: Streptococcus pneumoniae.
💊 Antibiotic prophylaxis: recommended for all initially, with duration guided by risk.
🔪 Indications for Splenectomy
- Trauma (most common in UK)
- Hereditary spherocytosis
- Immune thrombocytopenia (ITP)
- Myelofibrosis with massive splenomegaly
- Selected haematological malignancies
🧬 Medical Causes of Hyposplenism
- Sickle cell disease (functional asplenia)
- Coeliac disease (functional hyposplenism)
- Inflammatory bowel disease
🦠 Infection Risk
- Encapsulated organisms:
- Streptococcus pneumoniae (most important)
- Haemophilus influenzae type b
- Neisseria meningitidis
- Other risks:
- Capnocytophaga canimorsus (dog bites)
- Malaria, babesiosis
🩻 Blood Film Findings
- Howell–Jolly bodies
- Target cells 🎯
- Pappenheimer bodies
- Thrombocytosis
⚠️ Risks
- OPSI: rapid sepsis with high mortality (up to 50%)
- ↑ Risk of thrombosis
- ↑ Risk from intra-erythrocytic parasites (e.g. malaria)
🛡 Prevention
- Vaccination:
- Pneumococcal: PCV → PPV23 (≥8 weeks later), repeat PPV23 every 5 years
- Meningococcal: MenACWY + MenB
- Hib vaccine
- Annual influenza + COVID vaccination
- Antibiotic prophylaxis:
- Phenoxymethylpenicillin (penicillin V)
- Children: lifelong
- Adults: ≥2 years post-splenectomy; lifelong if high risk
- Emergency planning:
- Carry medical alert (“asplenia card”)
- Have rescue antibiotics at home
- Start immediately with fever and seek urgent care
- Travel advice:
- Malaria prophylaxis if endemic travel
- Prompt antibiotics after animal bites (e.g. co-amoxiclav)
📚 References
- UKHSA (Green Book): Immunisation of individuals with asplenia
- British Society for Haematology: Splenectomy guidelines
- NICE CKS: Asplenia and hyposplenism
