SPLENECTOMY

Main indications:
- ITP (who will benefit more)
- haemolytic anaemias esp. hereditary spherocytosis
- hypersplenism
- trauma
- Hodgkin/non-Hodgkin lymphoma

Post-splenectomy management:
 Immediate problem is thrombocytosis (↑ platelets to 600–1000 × 109/L) for 2–3 weeks with risk of
thromboembolism.
 Long-term risk is overwhelming infection (pneumococcus [especially] Haemophilus influenzae and
meningococcus), especially in young children in the first 2 years post-splenectomy – start AB asap:
penicillin, amoxycillin
 For elective surgery give immunisation at least 2 weeks before surgery. Splenectomy for trauma
(emergency) should have been accompanied by a pneumococcal and meningococcal vaccination at the time
of injury to minimize the risk of overwhelming post-splenectomy sepsis. This infection risk is greatest in
the first year after surgery.
 Lifelong prophylaxis should be considered in select patients such as those severely immunocompromised.

Prophylaxis
Education about risks and early recognition of infection (special care with malaria)
 Pneumococcal immunisation—2–3 weeks preoperative, repeat 5-yearly; avoid in pregnancy
 Haemophilus type B vaccine—once only if not immunized
 Meningococcus vaccine—every 5 years
 Influenza vaccine—annual
 Long-term penicillin: amoxycillin daily or phenoxymethylpenicillin bd
 Urgent hospital admission if infection develops - AB