What is the spleen?
Your spleen is an organ that usually sits underneath your ribs on the left side. It is purplish red in colour and is usually about 12x7 cm big. The spleen has several functions, which include:
- filtering out germs that can cause serious infections
- removing blood cells that are damaged or old
- creating some of the white blood cells that fight infection
- storing extra blood when it isn’t neededtoring extra blood when it isn’t needed
Why do people have their spleen removed (splenectomy)?
People may have their spleen removed because of:
- trauma (accidents)
- lood diseaseslood diseases
What conditions can lead to my spleen not working properly (also called “functional hyposplenism”)?
Conditions that affect the immune system (eg rheumatoid arthritis), some diseases of the blood (eg sickle cell disease) and some diseases where the normal tissue of the spleen is replaced by abnormal tissue (eg amyloidosis) can sometimes lead to the spleen not working properly. You can discuss whether this is a risk to you with your doctor.
What can happen if I don’t have a functional spleen (spleen has been removed or doesn’t work properly)?
Because your spleen is important for your body’s defence against germs, when your spleen is removed or doesn’t work properly you are at higher risk of infection, particularly from certain types of bacteria. This is very important as, although these infections do not happen very often, they can be life-threatening – so it’s important to take precautions to try to stop this from happening.
A way of thinking about this risk is that if 100 people without functioning spleens were followed for 10 years, between 1 and 5 of them would have a severe infection within that period of time. The risk is highest in children and in adults in the first few years after the spleen is removed. For people whose spleen is still present but doesn’t work properly the risk is high for the rest of your life.
It is important to get vaccinated against some of the bacteria that can cause severe disease for which we have vaccines available. Pneumococcal vaccination, meningococcal vaccination and Hib vaccination are all important, and it’s important to discuss with your doctor how frequently you need these vaccinations – some will be a once-off, others will need booster doses. An annual seasonal influenza vaccination is also recommended. You may need additional vaccines when travelling overseas – speak to your GP or travel doctor and make sure they know you don’t have a functional spleen as the advice to you may be different to that of other members of your travelling party.
Know when to take antibiotic medication
Antibiotics are often prescribed to be taken daily for the first two years after you have had your spleen removed, some people may be advised to take them daily for life. This is a hard thing to do so make sure you discuss it with your doctor if you are thinking of stopping the antibiotics and always make sure you have an emergency supply of antibiotics to hand (see below). Very young children may need to take them daily until they are vaccinated against pneumococcal infection with appropriate vaccines.
People without a functional spleen are advised to keep a full course of antibiotics on their person at all times. You should start taking the medication as soon as you get any sign of infection – such as chills, fever, a sore throat, severe headache, new abdominal pain or new cough. Ask your prescribing doctor how much you should take. After taking the first dose IMMEDIATE health advice should be sought to determine whether further treatment or testing is necessary. Make sure the person who gives
you that advice knows that you don’t have a functional spleen and understands that you are at high risk of severe bacterial infection.
Similarly you should seek urgent treatment for any animal bites that break the skin and take any antibiotics you are given to prevent infection until you have completed the course.
Being careful when travelling
Make sure you talk to your doctor or to a travel medicine centre before embarking on an overseas journey and make sure they consider the fact that you don’t have a functional spleen in their advice to you. Some diseases that are uncommon or not present in Australia (eg malaria, some types of meningococcal disease) can severely affect people without a spleen so extra medications, precautions or vaccinations may be required to help you travel more safely. You may be advised against travelling to areas where there is Falciparum malaria. You should also make sure you carry your emergency antibiotics with you at all times. If you are travelling to a country where English is not widely spoken think about asking someone who speaks/writes in that language to translate your patient advice card (provided on the NSW Health website or by your treating hospital) into the language of the country you are visiting.
Keep your Patient Advice Card up to date and carry it with you at all times
NSW Health has a patient advice card that you can print out and carry with you. Some hospitals will give you a similar card when you have had a splenectomy. It’s important to keep this card up to date and to carry it with you at all times. You should work with your doctor to update this card if:
- you change daily antibiotic medication or cease taking it
- you change your emergency antibiotic that you take
- you have an immunisation (so it can be recorded on the card)
You should carry this card at all times.
Inform healthcare providers
Make sure that you tell your health care providers, especially doctors and dentists, that you don’t have a functional spleen. Make sure you show people your card, especially if you have become unwell – sometimes health care professionals need to be reminded that not having a spleen can put you at higher risk of severe infection.
Medical Alert bracelet or necklace
You may wish to wear a medical Alert bracelet or necklace. Having a bracelet or necklace that has important information about your condition or a number to call for additional information may help healthcare professionals manage you if you forget your wallet card or if you are severely injured and are separated from your wallet. Talk to your GP about your options.