How can I prevent infection if I have had my spleen out?

If you do not have a spleen, or have a spleen that does not work well, you have an increased risk of developing some serious infections. The risk is reduced by: immunisation, taking regular low-dose antibiotics and taking full-strength antibiotics as soon as the first sign of infection develops.

What is the spleen?

The spleen is an organ in the upper left side of the abdomen. It helps to protect against infections. As blood passes through the spleen, special cells kill bacteria that may be present. Your spleen may be removed (splenectomy) for various reasons, for example, because of an illness that affects the spleen or if it is damaged by an injury. Also, the spleen may not work well in some diseases, for example, sickle cell disease, thalassaemia and lymphomas.

What is the risk without a spleen?

You can normally cope with most infections without a spleen. The spleen is just one part of the immune (defence) system. Other parts of the immune system protect against most bacteria, viruses and other germs. However, you have an increased risk of developing some serious infections if you do not have a spleen, or have a spleen that does not work properly. This complication is called overwhelming post-splenectomy infection (OPSI). The risk is small and OPSI is uncommon but very serious and often fatal it it occurs. Examples of serious infections that you are at increased risk from if you do not have a working spleen are pneumonia, meningitis, septicaemia (blood infection) and malaria.

What can I do to reduce the risk of infection?

Most infections that occur after splenectomy can be avoided through the following measures:

1. You should be immunised against the following:

Pneumococcus. This bacteria is a common cause of serious chest infection. You are likely to need a booster every few years but it is often needed more frequently than this so it is important to have a yearly blood test to check that you are still protected.

Haemophilus influenzae type b (Hib). This bacteria can cause chest infections and meningitis. Immunisation is now routine for all children but many adults will not have had it. It is important to have a yearly blood test to check that you are still protected.

Meningococcus. This bacteria can cause meningitis. Immunisation is with the meningococcal ACWY conjugate vaccine, which protects against four strains of the bacteria.

Influenza. The annual flu jab each autumn. The spleen is not needed to fight off the flu virus, however, some people with flu develop secondary chest infections from bacteria, which may lead to pneumonia. Therefore, it is best to prevent flu in the first place.

More information:

  • NHS UK (Meningitis)
  • NHS UK (Pneumococcal Disease and prevention)
  • NHS UK (Haemophilus influenzae type b infection)
  • NHS UK (Seasonal Influenza)

Travelling abroad?

  • Make sure that you have all the immunisations for the countries you visit.
  • If you are travelling abroad to high risk areas, for example the Middle East, you should receive the Meningococcal ACWY vaccine, even if you have had this in the past.
  • Also see the general information below about travelling abroad.

Surgery?

If you are going to have your spleen removed, discuss your immunisation status with your Doctor at least 2 weeks before surgery. In particular the Pneumococcal and Meningococcal ACWY vaccines are best given at least 2 weeks before your operation, however, it is never too late. If you have had your spleen removed, and are not immunised, get immunised as soon as possible. NB: immunisation does not completely prevent the risk of infection, it only protects against certain types of infection.

2. You will probably be advised to take low-dose antibiotics every day for life.

If you take a small dose of an antibiotic every day, it will prevent some serious infections. Penicillin is the usual antibiotic and most people do not have any side effects from the daily low dose. If you are allergic to penicillin other antibiotics are available.

More information:

3. Keep a course of full-strength broad-spectrum antibiotics handy.

Broad-spectrum antibiotics combat a wide range of bacteria. If you become ill with fever or other signs of infection, you should start a course of full-strength broad-spectrum antibiotics straight away. This is in addition to your regular low dose penicillin (or similar). You should then get medical advice quickly. Most feverish illnesses that you will have will be common coughs and colds due to viral infections. These are not serious and will be cleared by your immune system. The antibiotic, in hindsight, will usually not have been necessary. However, some serious infections start with symptoms similar to a cold and they can quickly develop if you do not have a working spleen. So, it is best to play safe and take a course of full-strength broad-spectrum antibiotics as soon as any feverish illness starts and see a Doctor promptly.

More information:

4. Human, dog or other animal bites

These can cause life threatening infections in a person with no spleen. You must seek urgent medical attention.

5. Carry a card or wear a bracelet or necklace which says that you do not have a spleen.

This would alert a Doctor to take rapid action if you are seriously ill and cannot tell him or her yourself. You can download a special card from www.dh.gov.uk (search for “splenectomy”). You can buy bracelets and necklaces from MedicAlert Foundation, Tel: 0800581420, www.medicalert.org.uk

Travelling abroad?

1. Malaria, meningitis and babeosis

You have an increased risk of developing these infections if you come into contact with the germs causing these diseases. It may be best to avoid any countries where these diseases are common. Do you really need to travel? If you do travel, make sure you are fully immunised.

Malaria

In particular a severe form of malaria is a concern for people without a spleen. You will need to take precautions such as mosquito nets and insect repellants as well as getting specialist advice about tablets to prevent malaria. You should seek advice from your Doctor as early as possible before you travel. Take the antimalarial tablets exactly as advised for maximum protection – this usually means starting the tablets before you travel.

More information about malaria:

Meningitis

See information above about immunisation. If you are travelling to high risk areas (such as Middle East) you will require vaccination, even if you have already had this in the past.

For more information about meningitis:

Babesiosis

This is a tick-borne infection common in the USA however this also occurs in Scotland, usually between May and September. To help prevent tick bites whilst out in the countryside wear clothing to cover exposed skin, especially long trousers. Seek urgent medical advice if you are bitten by a tick.

More information about Babesiosis:

2. Penicillin resistant infection

In some countries (such as Spain, Southern France, South Africa, USA, South East Asia), there is a high resistance to penicillin. It is recommended that your antibiotics are changed to a different regular antibiotic for the duration of your trip. Contact your Doctor before travelling.

3. Remember to take your course of full-strength broad-spectrum antibiotics with you.

Start straight away if any fever and seek urgent medical advice.