A splenectomy is the surgical removal of the spleen, a fist-sized organ situated in the upper left side of the abdomen. The spleen filters old or damaged red blood cells and stores platelets. It also acts as a specialized part of the immune system, using white blood cells to help the body fight off certain infections. While the organ is important for immune defense, a person can live a full and healthy life without a spleen, provided they adhere to specific, lifelong health protocols. The body has built-in systems that compensate for the loss of the organ.
Essential Functions the Body Reroutes
The spleen’s absence means its core responsibilities must be taken over by other organs. The liver is the primary organ that assumes the role of removing aged or defective red blood cells from the bloodstream. This compensatory mechanism ensures that blood filtration continues efficiently.
The bone marrow and lymph nodes increase their activity to pick up the slack in immune surveillance. These areas of the body contain specialized cells that help initiate immune responses and produce antibodies, taking over the spleen’s part in filtering pathogens. Although the body adapts well, the loss of the spleen’s specialized macrophages makes the individual more vulnerable to certain types of encapsulated bacteria, which is why specific precautions are mandatory.
Lifelong Strategies for Infection Prevention
The most serious health concern for an asplenic person is Overwhelming Post-Splenectomy Infection (OPSI), a rare but potentially fatal condition caused primarily by encapsulated bacteria like Streptococcus pneumoniae. The risk of OPSI is highest in the first few years following the splenectomy but remains a lifelong consideration. The infection can begin with minor, flu-like symptoms, such as fever, chills, or headache, and rapidly progress to a life-threatening state within 24 to 48 hours.
Immediate action upon developing a fever or feeling unwell is the most important survival strategy. Any unexplained fever requires immediate medical attention, often necessitating a trip to the nearest emergency room. Carrying a medical alert bracelet, necklace, or card is necessary to communicate the asplenic status instantly, especially in an emergency.
Informing all healthcare providers, including dentists and pharmacists, about the absence of a spleen is also necessary. This ensures that any signs of infection are treated with the necessary urgency and aggressive, broad-spectrum antibiotics. Patients are often supplied with a course of “standby” antibiotics to begin taking immediately if a fever develops and they cannot access medical care quickly, such as while traveling.
Required Immunization and Prophylactic Care
A structured and comprehensive vaccination schedule is required to compensate for the reduced ability to fight off infections caused by encapsulated bacteria. The primary focus is on protecting against:
- Streptococcus pneumoniae
- Neisseria meningitidis
- Haemophilus influenzae type b (Hib)
Ideally, these vaccinations are administered at least two weeks before a planned splenectomy to allow the body time to develop an immune response. If the surgery is an emergency, the vaccines are given shortly after the procedure once the patient is stable.
The pneumococcal vaccination schedule involves multiple doses, typically starting with a conjugate vaccine followed by a polysaccharide vaccine eight weeks later. Booster doses of the polysaccharide vaccine are required throughout life, usually every five years, because the protection may wane over time. Meningococcal vaccines are also mandatory, often administered in a two-dose series.
Annual vaccination against influenza is strongly recommended, as a respiratory infection can lower the body’s overall resistance to bacterial invasion. Some individuals, particularly children up to age five and those with underlying health conditions, are prescribed a daily prophylactic antibiotic. For adults, the emphasis shifts more toward the standby course of antibiotics and strict adherence to the vaccination schedule.
Practical Adjustments for Daily Living
Making minor adjustments to daily routines further supports a high quality of life without a spleen. Travelers must be particularly careful, especially when visiting countries with high rates of infectious diseases, such as malaria. A medical consultation before any international travel is necessary to discuss destination-specific risks and to ensure a full course of standby antibiotics is available.
Increased caution around animals, particularly dogs, is advised due to the risk of infection from the bacteria Capnocytophaga canimorsus, which is found in dog saliva. Any animal bite or scratch should be immediately and thoroughly cleaned and evaluated by a doctor for prophylactic antibiotic treatment.
General physical activities, including exercise and most sports, are safe and encouraged once the surgical recovery is complete. For a fully asplenic person, there is no organ to rupture, leaving them free to engage in most physical pursuits. Maintaining good hygiene, avoiding individuals with known infections, and ensuring all healthcare providers are aware of the asplenic status are simple, ongoing practices that manage the long-term risk and enable a normal lifestyle.