From the Guidelines
After a splenectomy, patients should receive immunization against encapsulated bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis, at least 14 days after surgery, and carry antibiotics for emergency use in case of fever, as recommended by the most recent guidelines 1. The goal of post-surgical care is to prevent complications, such as overwhelming post-splenectomy infection (OPSI), and ensure proper healing.
Key Recommendations
- Vaccination against encapsulated bacteria should be started no sooner than 14 days after splenectomy or spleen total vascular exclusion, with a Grade of Recommendation (GoR) of 1A 1.
- Patients should receive annual immunization against seasonal flu, as recommended by the guidelines 1.
- Antibiotic therapy should be strongly considered in the event of any sudden onset of unexplained fever, malaise, chills, or other constitutional symptoms, especially when medical review is not readily accessible, with a GoR of 2A 1.
- Patients should be educated on the risks of OPSI and the importance of prompt medical attention in case of symptoms, as emphasized by the guidelines 1.
Post-Splenectomy Care
Patients should be monitored for signs of infection, bleeding, or blood clots, and should have a follow-up appointment scheduled 1-2 weeks after discharge.
- Activity should be gradually increased, avoiding heavy lifting (over 10 pounds) for 4-6 weeks.
- Patients should be aware of the risks of OPSI and the importance of prompt medical attention in case of symptoms.
Antibiotic Prophylaxis
- Patients should carry antibiotics, such as amoxicillin 500mg or levofloxacin 500mg, for emergency use in case of fever, as recommended by the guidelines 1.
- Antibiotic prophylaxis is necessary in patients with asplenia/hyposplenia who are bitten by dogs and other animals, due to the increased risk of severe sepsis 1.
From the Research
Post-Splenectomy Care
- The care of patients after splenectomy involves preventing infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae 2, 3, 4, 5, 6.
- Vaccinations against pneumococcal, meningococcal, and Haemophilus influenzae type b are recommended for patients after splenectomy, and should be given at least 14 days before a scheduled splenectomy, or after the fourteenth postoperative day 4, 5, 6.
- Patients with asplenia are at risk for infections due to less common organisms such as Capnocytophaga, Babesia, and malaria, and may require antibiotic prophylaxis and patient education to prevent these infections 6.
- Thromboembolic complications, including deep-vein thrombophlebitis and pulmonary embolism, can occur after splenectomy, particularly in patients with myeloproliferative disease and cirrhosis, and may require anticoagulation therapy 2.
- Registry programs for asplenic patients, such as Spleen Australia, can reduce the risk of infection with encapsulated organisms by providing education, clinical guidance, and annual vaccination reminders 3.
Preventive Measures
- Prophylactic antibiotics may be prescribed for patients at high risk of infection, such as those with immunocompromise or a history of overwhelming post-splenectomy infection (OPSI) 2, 6.
- Patient education is crucial in preventing infections, and patients should be informed about the increased risk of infection and the importance of seeking medical attention promptly if symptoms occur 5, 6.
- Emergency antibiotics should be prescribed for patients with asplenia in case of infection, and patients should be given a personal post-splenectomy pass to alert healthcare providers to their increased risk of infection 5.
Long-Term Care
- Patients with asplenia require long-term follow-up to monitor for infections and other complications, and to ensure that they receive recommended vaccinations and booster doses 6.
- Dedicated teams or clinics focused on patient education and monitoring can improve vaccine coverage rates and reduce the risk of infection in patients with asplenia 6.