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).
Check immunisation history with patient, administer vaccinations appropriately (see table 2 below) and inform the patient's GP.
| 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. | |
Give one dose of each vaccine. They may be given at the same time.
| Vaccinations | Notes / Comments |
| Meningococcal group B (Bexsero® or Trumenba®) |
Give one dose of Meningococcal ACWY conjugate vaccine and one dose of the Meningococcal B vaccine. After 4 weeks give a second dose of the Meningcoccal B vaccine. |
| Meningococcal Group ACWY conjugate (Menveo® or Nimenrix®) | |
| Influenza vaccine | Recommended yearly to all adult patients during the influenza season. |
| Pneumococcal polysaccharide vaccine (PPV23, Pneumovax® 23) | Give at the same time as the Meningococcal ACWY conjugate vaccine. For all patients re-immunisation is recommended every 5 years. |
| For further information see the Green Book (Immunisation against Infectious Diseases) via https://www.gov.uk/government/organisations/department-of-health. | |
Amoxicillin oral 500mg once daily or
Phenoxymethylpenicillin oral 250mg twice daily.
If true penicillin / beta-lactam allergy:
Erythromycin oral 500mg once daily.
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.
Guideline reviewed: January 2023
Page last updated: January 2023
