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Splenectomy

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Related Subjects: | Sideroblastic Anaemia | Splenectomy

Basic Functions of the Spleen

Filtration: The spleen filters and removes old or damaged red blood cells from the bloodstream.
Immune Response: It plays a role in the immune system by producing lymphocytes and facilitating the production of antibodies. It also traps and destroys bacteria, viruses, and other pathogens.
Storage of Blood: The spleen acts as a reservoir for blood, storing red blood cells and platelets. It can release these in response to injury or bleeding.
Iron Recycling: It helps recycle iron from hemoglobin as red blood cells are broken down, providing the body with a reusable source of iron.
Hematopoiesis (in fetal life): During fetal development, the spleen plays a role in producing red and white blood cells. This function decreases after birth.

Indications for Splenectomy

Cause	Clinical Indications	Post-Operative Guidance
Trauma	Splenic rupture due to blunt abdominal trauma (e.g., motor vehicle accidents, sports injuries).	Monitor for signs of haemorrhage, provide immunizations (e.g., pneumococcal, meningococcal, Haemophilus influenzae type b), and educate on infection risk and the need for prompt antibiotic use for febrile illness.
Hematological Disorders	Hereditary spherocytosis, autoimmune haemolytic anaemia, idiopathic thrombocytopenic purpura (ITP), thalassemia, sickle cell disease (for splenic sequestration crisis).	Long-term prophylactic antibiotics (especially in children), regular immunizations, and patient education on recognizing symptoms of infection. Lifelong follow-up for potential complications like thrombosis and sepsis.
Splenic Neoplasms	Primary or metastatic tumours of the spleen, such as lymphoma or splenic angiosarcoma.	Regular follow-up with oncology, post-splenectomy vaccinations, and monitoring for any signs of infection or recurrence. Consideration of chemotherapy or radiotherapy if indicated.
Infectious Diseases	Splenic abscess, granulomatous diseases (e.g., tuberculosis, sarcoidosis), or chronic infections unresponsive to medical therapy.	Comprehensive infection prophylaxis with vaccinations, possible long-term antibiotics, and regular follow-up to monitor immune status and potential recurrence.
Portal Hypertension	Hypersplenism secondary to liver cirrhosis or portal vein thrombosis.	Management of underlying liver disease, regular follow-up with hepatology, and monitoring for signs of portal hypertension recurrence. Post-splenectomy vaccines and infection prevention measures are critical.
Immune Thrombocytopenic Purpura (ITP)	Refractory ITP not responsive to corticosteroids or immunoglobulins.	Regular platelet count monitoring, post-splenectomy immunizations, and awareness of increased risk of infections and thrombosis. Possible need for additional immunosuppressive therapy.
Hypersplenism	Overactivity of the spleen leading to pancytopenia, commonly associated with conditions like cirrhosis or lymphoma.	Post-splenectomy prophylaxis against infections, regular blood count monitoring, and management of the underlying condition contributing to hypersplenism. Lifelong follow-up is essential.
Cysts or Benign Tumours	Large or symptomatic splenic cysts, benign tumours causing discomfort or risk of rupture.	Ensure complete removal of the lesion, regular follow-up imaging, and standard post-splenectomy care including vaccinations and infection risk management.
Sickle Cell Disease	Splenic sequestration crisis or functional asplenia due to repeated infarctions.	Immunizations, regular prophylactic antibiotics, patient education on infection risks, and monitoring for other complications related to sickle cell disease. Consideration for hydroxyurea therapy or other sickle cell-specific treatments.

Management Post Splenectomy: UK Guidance for Post-Splenectomy Care

Post-splenectomy patients are at increased risk of infections, particularly from encapsulated bacteria. The following guidance outlines the standard care and preventive measures recommended in the UK:

Vaccinations

Pneumococcal Vaccine: Administer a dose of the conjugate vaccine (PCV13) at least 2 weeks before splenectomy if elective or as soon as possible after emergency splenectomy. Follow-up with the polysaccharide vaccine (PPV23) at least 8 weeks after PCV13. Booster doses of PPV23 are recommended every 5 years.
Haemophilus influenzae type b (Hib) Vaccine: A single dose should be given if not previously immunized.
Meningococcal Vaccines: Administer the MenACWY conjugate vaccine and the MenB vaccine. Booster doses of MenACWY are recommended every 5 years.
Annual Influenza Vaccine: Annual influenza vaccination is strongly recommended.

Antibiotic Prophylaxis

Lifelong Antibiotic Prophylaxis: For most patients, lifelong antibiotic prophylaxis with penicillin V (phenoxymethylpenicillin) is recommended. In case of penicillin allergy, erythromycin or an alternative macrolide can be used.
Emergency Antibiotics: Patients should be provided with a supply of emergency antibiotics (e.g., amoxicillin or ciprofloxacin) to take at the first sign of infection if medical care is not immediately accessible.

Patient Education and Emergency Measures

Education: Patients should be informed about their increased risk of infection and the importance of prompt medical attention if they develop symptoms of infection.
They should be advised to carry a medical alert card or wear a medical alert bracelet indicating their asplenic status.
Travel Advice: Patients should be advised about the risks of travel to areas endemic with malaria or other infections and provided with appropriate prophylactic measures.

Long-Term Follow-Up

Regular Health Checks: Patients should have regular check-ups to ensure continued adherence to prophylactic measures and to update vaccinations as necessary.
Risk of Thrombosis: Consideration should be given to the increased risk of thrombosis, and appropriate measures should be discussed based on the individual patient’s risk profile.

PLEASE NOTE LEGAL ADVICE: The contents are under continuing development and improvements and may contain errors of omission or fact. Feedback vital and always welcome at drokane at gmail.com. This is not to be used for the assessment, diagnosis or management of patients. It should not be regarded as medical advice. It is only for educational purposes. Please adhere to your local protocols. If you are unwell please seek healthcare advice from your doctor. This does not replace senior or specialist advice. If you do not accept this then please do not use the website. If you need medical advice, please consult a doctor or other appropriate medical professional. If you are a medical professional and you need advice then speak to your senior or colleagues.

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