The main risk following splenectomy is severe infection

  • greatest risk for children
  • commonest infection is Stretococcus pneumoniae (Pneumococcal sepsis)
  • risk of death from severe infection in normal people (with spleen) is 1 in 30,000 per year. After splenectomy the risk is 8x for adults and 50x for children (Or of 100 people without a spleen 1-5 of them would develop severe infection over 10 years.
  • risk seems greatest in childhood and for 2 years after splenectomy, but lifelong continued risk.

Reducing the Risk of Infection

  • Vaccination

Initial Vaccination (2 weeks before splenectomy or >14 days after)

AgentVaccine
Pneumococcus 13 valent conjugate vaccine – 13vPCV (eg Prevenar 13) im
Meningococcus
B		Meningococcal B recombinant vaccine (MenBV) (eg Bexsero) im
Meningococcus ACWYMeningococcal quadrivalent conjugate ACWY vaccine (4vMenCV)(eg Menactra, Menveo, Nimenrix) im
Haemophilus Influenza Type BConjugate HiB vaccine (HiB) (Eg Hiberix, Act-HiB) im
InfluenzaInfluenza vaccine – and annually pre-winter
Initial vaccination (2 weeks before splenectomy or >14 days after)

8 weeks later

AgentVaccineBooster
Pneumococcus23 valent pneumococcal polysaccharide vaccine (23vPPV) (eg Pneumovax 23) im/sc5 years
MeningococcusMeningococcal quadrivalent ACWY vaccine (4vMenCV)
Meningococcal B recombinant vaccine (MenBV)		5 years for ACWY only
(no booster for B)
Haemophilus influenzae BNilNil
8 weeks later
  • Regular (prophylactic) antibiotics:
    • Penicillinn V 250mg bd (125mf if < 6 years old)
    • If penicillin allergy: erythromycin 250mg bd or roxithromycin 150mg/day
    • ? stop after age 16 or 2 years after splenectomy in adults (some continue lifelong)
  • Emergency antibiotic supply:
    • alternative to (or in addition to) prophylactic antibiotics
    • Home supply of: amoxycillin 3g; or erythromycin 1g qid; or roxithromycin 300mg – if fever occurs take 1 dose and seen medical advice
  • Caution with minor infections:
    • Advise to seek medical assistance at onset of infection
  • Precautions against malaria:
    • avoid mosquito bites in maaria areas(repellants, nets, DEET, long sleeves)
    • anti-malaria prophylaxis tablets
  • Education of family and Medic-Alert bracelet

Spleen Australia website has good information and a chart of vaccine with timeline.

Updated March 2019