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 the patient's GP. 

Table 1 - Vaccination schedules for pneumococcal vaccine

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

Table 2 – Vaccinations for adults regardless of previous vaccinations

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

Antibiotic prophylaxis

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