Spleen and Immune System
Prevention
Overwhelming post-splenectomy infection (OPSI) is to some extent, preventable by several interventions4-6.
These are:
- Surgical conservation of the spleen
- Immunization against:
- S. pneumoniae
- Haemophilus influenzae type b
- Neisseria meningitidis
- Prophylactic antibiotics
- Stand-by antibiotics
- Patient education
- Medical alert bracelet
Asplenic patients living in malaria-endemic areas require optimal prophylaxis
Prophylactic Antibiotics
Prophylactic antibiotics (generally penicillin) are recommended as daily lifelong treatment. There are no randomized studies to establish the benefit of antibiotics in survivors of pediatric malignancy and patients become unhappy about continuously taking this drug. Most patients, over time, discontinue the use of antibiotics.
However, patients should receive antibiotic prophylaxis for dental work.
Stand-by Antibiotics:
Patients should have stand-by antibiotics available (generally penicillin) to take at the first onset of febrile illness if the patient is not on daily prophylaxis.
Medical care should be sought promptly for fevers higher than 38.5°C.
Immunizations:
Patients should be immunized against:
Immunizations should be given at least 14 days before a scheduled splenectomy, or given after the fourteenth postoperative day.
Links:
Post-splenectomy vaccine guideline
COG Survivorship Guidelines: Precautions for people without a functional spleen
Immunizations for Patients With Lymphoma, Hodgkin Lymphoma, Myeloma and Leukemia (BCCA)
Vaccination information for HCPs: Immunization Action Coalition
Medic Alert bracelet:
An unconscious patient cannot communicate that he or she had a splenectomy.
Because of the risk of overwhelming and rapidly progressive infection, they should wear a Medic Alert bracelet.
Link: Medic Alert Canada
