From the Guidelines
Long-term side effects of splenectomy include an increased lifelong risk of serious infections, particularly from encapsulated bacteria like Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, which can be life-threatening. To manage these risks, patients should receive appropriate vaccinations (pneumococcal, meningococcal, Haemophilus influenzae type b, and annual influenza vaccines) as recommended by the most recent guidelines 1. The vaccination programs should be started no sooner than 14 days after splenectomy, and patients should be informed that immunization can only reduce the incidence of overwhelming post-splenectomy infection (OPSI) 1. Patients may also experience thrombocytosis (elevated platelet counts), which can increase the risk of blood clots and thrombotic events, and other potential complications include a slightly higher risk of certain cancers, increased susceptibility to parasitic infections, and a higher likelihood of developing pulmonary hypertension 1. In addition to vaccinations, patients should maintain prophylactic antibiotics (typically penicillin or amoxicillin) for at least 2-5 years post-surgery or lifelong in high-risk patients, and seek immediate medical attention for any fever or signs of infection 1. Some key points to consider include:
- Patients should be given an antibiotic supply in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible 1
- The recommended options for emergency standby in adults include amoxicillin, levofloxacin, or moxifloxacin 1
- Patients should carry medical identification indicating their asplenic status and be educated about the importance of prompt treatment for animal bites and travel-related infection risks 1
- Community physicians should be aware of the asplenic/hyposplenic condition, in order to provide them with the most appropriate level of care 1.
From the Research
Long-term Side Effects of Splenectomy
The removal of the spleen, also known as splenectomy, can lead to several long-term side effects. Some of the most significant risks include:
- Increased risk of infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis 2, 3, 4
- Overwhelming Post-Splenectomy Infection (OPSI), a medical emergency that can rapidly progress to fulminant infection and death in 50% of cases within 48 hours 2
- Thromboembolic complications, including deep-vein thrombophlebitis, pulmonary embolism, and portal vein thrombosis 3
- Increased risk of cancer, although the exact mechanisms and magnitude of this risk are not fully understood 3
Prevention and Management of Long-term Side Effects
To prevent and manage these long-term side effects, several measures can be taken:
- Vaccination against pneumococcal, H. influenzae type b, and meningococcal infections, ideally 2-6 weeks before scheduled splenectomy or 2 weeks after urgent surgery 2, 4
- Antibiotic prophylaxis, such as phenoxymethyl-penicillin, for at least 2 years after splenectomy and lifelong prophylaxis for high-risk patients 2
- Patient education on the risks of infection and the importance of seeking early medical attention for febrile illnesses 2, 5
- Consideration of splenic autotransplantation and lifelong prophylactic antibiotic therapy in some cases, although the clinical value of these approaches remains to be proven 5
Special Considerations
Certain patient populations may be at higher risk for long-term side effects after splenectomy, including:
- Children, who are more susceptible to infections and OPSI 3
- Patients with underlying malignant or nonmalignant hematologic diseases, who may be at higher risk for infections and thromboembolic complications 4
- Patients who have undergone splenectomy for trauma, who may be at higher risk for thromboembolic complications and infections 3