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Splenectomy (having your

spleen removed)
The spleen is an organ that filters the blood and helps to guard against infection. If you have
lymphoma, you may need to have a splenectomy (operation to remove your spleen). After this
type of surgery, you need to take extra precautions against infections because your body is
less able to fight them.

What is the spleen and what does it do? (page 1)

What is a splenectomy? (page 2)
What does splenectomy involve? (page 4)
What happens after the operation? (page 5)
How can you manage the risk of infection without a spleen? (page 5)
Further resources (page 8).

What is the spleen and what does it do?

The spleen is an organ that is part of the lymphatic system (your body’s drainage system). It is
about the size of a clenched fist and lies just under the ribcage on the left-hand side of
your body.

The diagram on the next page shows the location of the spleen.

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The spleen has 2 major roles:

filtering the blood – removing old red blood cells and platelets that are worn out
helping to fight infection by making antibodies, storing several types of white blood cells
and filtering germs such as bacteria and viruses out of the blood.

We have more information about the lymphatic system, which you can read on our website at
www.lymphomas.org.uk. You can also print this information at home or, if you prefer, our
helpline can send you copies. Please email at information@lymphomas.org.uk or call on
0808 808 5555.

What is a splenectomy?
Splenectomy is an operation to remove the spleen.

You may need a splenectomy:

if your spleen doesn’t work properly

if your spleen has been affected by injury or disease
if your spleen is enlarged (swollen) and it is causing problems (eg removing healthy red
blood cells as well as old, damaged ones).

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An enlarged spleen doesn’t always cause symptoms but you may have symptoms like pain,
fatigue, or frequent infections. You might also feel full quickly after eating. Doctors can often
tell by feeling your abdominal (tummy) area if your spleen is enlarged. A blood test, MRI scan
or CT scan confirms this.

Occasionally, people are diagnosed with lymphoma after their spleen has been removed for
an unrelated medical reason. Upon examination of the spleen, doctors may find lymphoma,
having not previously suspected it.

Splenectomy is not used so often for lymphoma these days. It used to be done as part of the
staging process (to see how far Hodgkin lymphoma, for example, had grown and spread).
Nowadays, though, staging is done with scans.

We have more information about staging and scans, which you can read on our website at
www.lymphomas.org.uk. You can also print this information at home or, if you prefer, our
helpline can send you copies. Please email at information@lymphomas.org.uk or call on
0808 808 5555.

In some situations, splenectomy might be part of your treatment for lymphoma. Lymphoma
can spread to the spleen and make it work harder than it needs to. As a result, the spleen
becomes enlarged and starts to remove healthy red blood cells from the blood, as well as
damaged ones. When this happens, you might become anaemic and your doctor may
suggest that you have a splenectomy.

We have more information about anaemia, which you can read on our website at
www.lymphomas.org.uk. You can also print this information at home or, if you prefer, our
helpline can send you copies. Please email at information@lymphomas.org.uk or call on
0808 808 5555.

In some cases of splenic marginal zone lymphoma (SMZL), an uncommon type of lymphoma,
the lymphoma is mainly in the spleen. If this is the case, splenectomy may be a good
treatment choice.

We have more information about SMZL, which you can read on our website at
www.lymphomas.org.uk. You can also print this information at home or, if you prefer, our
helpline can send you copies. Please email at information@lymphomas.org.uk or call on
0808 808 5555.

If you have your spleen removed, your immune system will not work as well as it used to. This
doesn’t mean you have no protection – your liver, bone marrow and lymph nodes (glands)
take over many of the functions of your spleen. However, certain infections might take hold
more quickly. You are also more vulnerable to certain rare but potentially serious infections.

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What does splenectomy involve?
Splenectomy is a straightforward operation and people usually recover well. The operation
can be performed either as open surgery or as laparoscopic surgery (keyhole or minimally
invasive surgery). Both operations are carried out under general anaesthetic. Your consultant
will discuss the operation with you. He or she should help you to understand the purpose,
process and what the implications are. As with any surgery, splenectomy is associated with
some risks, such as those related to having an anaesthetic.

Laparoscopic (keyhole) surgery

Laparoscopy is a type of surgery that allows your surgeon access to your abdomen (tummy)
without making large incisions (cuts) through your skin. Your surgeon is likely to suggest that
you have laparoscopic surgery if possible.

During the procedure, your surgeon:

makes several small incisions (cuts) in your abdomen. Each incision is up to 1.5cm (just
over half an inch) long
guides a laparoscope (an instrument that has an eyepiece with a light and camera
attached to a tube) through one of the small incisions to see inside your body. The
images are relayed to a TV screen so that the rest of the operating team can see them
passes small instruments through the other incisions to remove your spleen. Your
surgeon might pump gas into your abdomen to make it easier to operate. The gas is let
out after the operation.

After the splenectomy, all incisions are stitched closed and dressed. You may be able to go
home later the same day or you might stay in hospital overnight.

The advantages of laparoscopic surgery over open surgery, are:

less bleeding and pain

shorter time in hospital
quicker recovery.

Laparoscopic surgery may take a little longer than open surgery. Occasionally, if there are
complications, your surgeon may have to switch to open surgery during the procedure. He or
she will discuss this possibility with you before the operation.

Open surgery

Open surgery is a bigger operation that laparoscopic surgery. During open surgery, a surgeon
makes a larger incision (of several inches) to see inside your body and remove your spleen.

After the operation, the incision is stitched closed and dressed. You may have to stay in
hospital for a few days to recover.

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Complications

There are risks of complications with any surgery. Some of these risks are because you do
not move around so much in the time just after the operation. To help reduce these risks, a
physiotherapist will give you breathing and leg movement exercises to do at home. The
purpose of these exercises is to lower your risk of chest infection or of getting a blood clot
during the recovery period.

A relatively common complication after surgery is wound infection. If you see any
redness, swelling or oozing around your wound(s), or if you develop a temperature of
38°C or above, contact your GP or hospital straightaway. You may need antibiotics.

More serious complications are very rare. They include a severe reaction to anaesthetic or
damage to another organ or major blood vessel during the operation itself. Your surgeon
should discuss these risks with you before your operation.

What happens after the operation?

You are likely to have some pain or discomfort at first following your operation. Your doctor
should prescribe painkillers for you to take in hospital and at home. Tell your doctor or nurse if
you are in pain after taking your medication. You may need a different type of painkiller or a
higher dose.

After open surgery, you will have a scar on your upper abdomen, which will gradually fade.
Laparoscopic surgery will leave a number of smaller scars. These will also gradually fade.

You should be able to eat and drink as normal soon after the operation. Your surgeon will tell
you how to look after yourself at home. If you go home on the day of your operation, it is
important that someone stays with you for at least the first 24 hours. This is so that they can
keep an eye on you and do any necessary tasks while you rest.

Everyone is different but usually recovery takes a few weeks – talk to your surgeon or nurse
about when you can expect to get back to your normal activities, including driving.

How can you manage the risk of infection without

a spleen?
Anyone without a spleen is at greater risk of infection, but if you’ve had lymphoma and
chemotherapy, your risk is even higher. This is because both chemotherapy and the
lymphoma itself affect your immune system.

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Understanding the risks and knowing what you should and shouldn’t do is key to protecting
yourself from infection. Read all relevant information given to you and ask your partner or
carer to read it too. It is important that you are able to recognise signs of infection and that you
know when to seek medical advice. If there is something you don’t understand, ask your
doctor to explain it to you. Once you are familiar with the risks, you should be able to carry on
with your regular routines.

The risk of severe infection lowers with time, but having no spleen may mean that it never
goes away completely. You could also pick up other infections more easily throughout your
lifetime. Follow the advice of your medical team to protect yourself. It’s also advisable to
remind your GP and dentist that you have had a splenectomy each time you visit so they can
bear this in mind when considering any treatment options and medication for you.

We give some general advice below about how to help prevent infections. Speak to your
medical team for specific guidance based on your individual circumstances.

Be vigilant for signs of infection

Contact your GP straightaway if you have any signs of infection, including but not limited to:

fever (temperature above 38°C in adults)

shivering
chills and sweating
feeling generally unwell, confused or disoriented (lost or thrown off)
earache, cough, sore throat or mouth
redness and swelling around skin sores or intravenous lines
diarrhoea
a burning or stinging sensation when passing urine
unusual vaginal discharge or itching
unusual stiffness of the neck and discomfort around bright lights
severe headaches.

Your medical team should work with you to prevent infection.

If you don’t have a spleen, there is a risk of overwhelming post-splenectomy infection (OPSI).
This is a very small risk, but OPSI is serious and can be life-threatening. Contact your
medical team immediately if you suspect you might have any signs of serious infection.

Be prepared in case of an emergency

It is advisable to carry a card or wear a MedicAlert bracelet, necklace or watch. This gives
other people vital information, eg that you do not have a spleen and contact details of your
next of kin, in case of an emergency. See page 8 of this information sheet for details about
where to buy MedicAlert jewellery.

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Keep an emergency supply of antibiotics at home (or with you if you are travelling). Make sure
you start treatment as soon as possible if you develop an infection, particularly if you aren’t
taking daily antibiotics. Check the expiry dates regularly.

Have necessary vaccinations

If time allows, you should have some vaccinations at least 2 weeks before your operation to
make sure you are as well protected as possible. These include:

the Hib (haemophilus influenza B) vaccine

meningitis vaccines
pneumococcal vaccine against pneumonia.

If you don’t have these before your operation, you should have them in the weeks afterwards.

After a splenectomy, you need to have a yearly flu vaccination for the rest of your life. Talk to
your doctor about any other vaccinations you may need and how often you should have them.
If you travel to another country, you may need extra vaccinations.

Take any long-term antibiotics you are given

Vaccinations do not protect you from everything. You might need low-dose antibiotics (usually
penicillin) for at least 2 years after your operation to help prevent an infection. If you are
allergic to penicillin, you might be given erythromycin or a similar antibiotic.

People at high risk of infection following a splenectomy may have to take low-dose antibiotics
every day for the rest of their lives. Speak to your doctor about this. Your doctor is also likely
to suggest that you keep a course of antibiotics at home, in case you need them quickly. If
you get a sore throat, temperature or other signs of infection, take the first dose and then
contact your doctor straightaway.

Protect yourself when travelling abroad

If you are planning a trip abroad, talk to your doctor about the risks and about any extra
immunisations you need. Have this conversation in plenty of time – it can take several weeks
to have a full course of travel vaccinations.

Without a spleen, you are at a higher risk of getting malaria (a very serious tropical disease
spread by some mosquitoes). Avoid visiting countries that have malaria. If you do have to go,
seek advice from your doctor about which anti-malaria tablets to take. Make sure you take the
full course, including before and after you travel.

As well as anti-malaria tablets, the best way to avoid malaria is to protect yourself against
mosquito bites. Use a net at night, always cover all exposed skin with insect repellent
(including during the day) and keep your arms and legs covered whenever possible.

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We have more information about travelling abroad and foreign travel vaccinations, which you
can read on our website at www.lymphomas.org.uk. You can also print this information at
home or, if you prefer, our helpline can send you copies. Please email at
information@lymphomas.org.uk or call on 0808 808 5555.

Day-to-day general precautions

Take day-to-day precautions to minimise the risk of getting cuts and scratches. Wear gloves
for gardening and take extra care in the kitchen to avoid bad nicks and cuts from knives and
scissors. If you are bitten or scratched by an animal (eg you are bitten by a dog), contact your
doctor straightaway – some infections transmitted that way can be particularly dangerous for
people without a spleen.

Speak to your doctor as soon as possible if you have any concerns about your health.

Further resources
MedicAlert is a charity that works in partnership with the NHS to sell ID bracelets, necklaces
and watches marked with details of medical conditions.

01908 951045
www.medicalert.org.uk
info@medicalert.org.uk

NHS choices (www.bit.ly/1Rsb3JN) has information about splenectomy.

Sources used
These are a few of the sources we used to prepare this information. The full list of sources is
available on request. Please contact us by email at publications@lymphomas.org.uk or
phone on 01296 619409 if you would like a copy.

Davies JM, et al. Review of Guidelines for the Prevention and Treatment of Infection in
Patients with an Absent or Dysfunctional Spleen. Prepared on behalf of the British Committee
for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force.
British Journal of Haematology, 2011, 155:308–17.

Salisbury D and Ramsay M, Public Health England. Immunisation of individuals with

underlying medical conditions. In The Green Book, 2013. Chapter 7 (online). Available at:
www.bit.ly/1myP1H6 (accessed Nov 2015).

Newland AC, et al. Preventing severe infection after splenectomy. British Medical Journal,
2005, 331: 417–8.

NHS Choices, 2014. Spleen disorders and splenectomy. Available at: www.bit.ly/1Rsb3JN
(accessed March 2016).

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NHS Choices, 2015. Having laparoscopy. Available at: www.bit.ly/1ToRR5C (accessed
March 2016).

Acknowledgements
With thanks to Dr Paul Revell, member of our Medical Advisory Panel and formerly Consultant
Haematologist at Stafford Hospital, for reviewing this information.

We would also like to thank the members of our Reader Panel who gave their time to review
this information.

Content last reviewed: March 2016

Next planned review: March 2019

LYMweb0046/Splenectomy/2016v2

We continually strive to improve our resources for people affected by lymphoma and we
would be interested in any feedback you might have about this information. Please
visit www.lymphomas.org.uk/feedback or email publications@lymphomas.org.uk if you have
any comments. Alternatively please phone our helpline on 0808 808 5555.

If you have found this information useful and would like to help make it available to other
people coping with lymphoma, then please consider making a donation to support our work
at www.lymphomas.org.uk/donate. We rely totally on voluntary donations. Thank you.

Disclaimer

We make every effort to make sure that the information we provide is accurate but it should not be relied upon to reflect the current state of medical research, which is
constantly changing. If you are concerned about your health, you should consult your doctor. The Lymphoma Association cannot accept liability for any loss or damage
resulting from any inaccuracy in this information or third party information such as information on websites we link to.

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