Patients with absent or non-functioning spleen

A non-functioning spleen may be due to blood dyscrasia, coeliac disease, inflammatory bowel disease, bone marrow or stem cell transplant, dermatitis herpetiformis or may be congenital.
Patients with absent or non-functioning spleen are at increased risk of overwhelming infection (particularly with Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, influenza and malaria in travellers).

General Management

Check immunisation history with patient, administer vaccinations appropriately (see table 2 below) and inform patient's GP.

Table 1 - Vaccination schedules for splenectomy patients

Procedure	Time schedule for vaccinations
Planned splenectomy	*4-6 weeks pre-operatively. If this is not possible, then 2 weeks pre-operatively.
Unplanned splenectomy	2 weeks post-operatively (antibody response may be better).
Completion of radio- or chemotherapy	Delay vaccination for at least 3 months.
Bone marrow transplant	9-12 months post transplant.
*For further information see the Green Book (Immunisation against Infectious Diseases) via https://www.gov.uk/government/organisations/department-of-health or contact the immunology department.

Table 2 – Vaccinations

Vaccinations	Notes / Comments
Haemophilus influenzae type b (Hib)	Adults who have been fully immunised with Hib /MenC as part of routine vaccination programme give: combined Hib/MenC vaccine and Meningococcal B vaccine. After 4 weeks give the MenACWY conjugate vaccine and a second dose of the Meningcoccal B vaccine.
Meningococcal group B (Bexsero^®)
Meningococcal Group C conjugate (MenC)
Influenza vaccine	Recommended yearly to all adult patients.
Pneumococcal vaccine	Give at same time as Hib/MenC vaccine. For all patients re-immunisation is recommended every 5 years
If immunisation unknown / cannot be clarified or for further information see the Green Book (Immunisation against Infectious Diseases) via https://www.gov.uk/government/organisations/department-of-health or contact the immunology department.

Antibiotic prophylaxis

Amoxicillin oral 500mg every 24 hours.

If true penicillin / beta-lactam allergy:

Erythromycin oral 500mg every 24 hours.

All patients with an absent or dysfunctional spleen should receive prophylactic antibiotics for at least 2 years, but ideally for life. Prophylactic antibiotics should be started immediately post surgery.

Last reviewed February 2018