If you do not have a spleen, or have a spleen that does not work well, you have an increased risk of developing some serious infections. The risk is reduced by: immunisation, taking regular low dose antibiotics, and taking full-strength antibiotics as soon as the first sign of infection develops.
What is the spleen?
The spleen is an organ in the upper left side of the abdomen. It helps to protect against infections. As blood passes through the spleen, special cells kill bacteria (bugs) that may be present.
Your spleen may be removed (splenectomy) for various reasons. For example, because of an illness that affects the spleen, or if it is damaged by an injury. Also, the spleen may not work well in some diseases. For example, sickle cell disease, thalassaemia, and lymphomas.
What is the risk without a spleen?
You have an increased risk of developing some serious infections if you do not have a spleen, or have a spleen that does not work properly. However, you can normally cope with most infections without a spleen. The spleen is just one part of the immune (defence) system. Other parts of the immune system protect against most bacteria, viruses, and other bugs.
Examples of infections that are more likely to develop if you do not have a working spleen are: pneumonia, meningitis, and malaria.
What can I do to reduce the risk of infection?
1. You should be immunised against the following:
- Pneumococcus. This bacterium is a common cause of serious chest infection. A booster is normally advised every 5 years.
- Haemophilus Influenzae type B (HIB). This bacterium can cause chest infections and meningitis. Immunisation against HIB is now routine for all children. But, many adults will not have had it, so you may still need it if you did not have it as a child.
- Group C meningococcus. This bacterium can cause meningitis. Again, it is routine for all children to be immunised against this. But, many adults will not have had it.
- Influenza - the annual 'flu jab each autumn. The spleen is not needed to fight off the 'flu virus. However, some people with 'flu develop secondary chest infections from bacteria which may lead to pneumonia. Therefore, it is best to prevent 'flu in the first place.
- Travelling abroad? Make sure that you have all the immunisations advised for the countries you visit. In particular, you should be immunised against Group A meningococcus if you are visiting certain hot counties where this is a risk.
- Children should have all the other usual childhood immunisations. A separate page describes the routine immunisation programme.
If you are to have a planned operation to remove your spleen, then review your immunisation status with a doctor at least two weeks before surgery. In particular, the pneumoccocal immunisation is best given at least two weeks before the spleen is removed.
However, it is never too late. If you had your spleen removed in the past and are not immunised, get immunised as soon as possible.
Also, if you have been diagnosed as having a non-working spleen, then get immunised as soon as possible.
2. Take low dose antibiotics every day for life
If you take a small dose of an antibiotic each day, it will prevent some serious infections. Penicillin is the usual antibiotic prescribed. Most people do not have any side-effects from the daily low dose. If you are allergic to penicillin, other antibiotics are available.
3. Keep a course of full-strength broad-spectrum antibiotics handy
Broad-spectrum antibiotics combat a wide range of bacteria. If you become ill with fever or other signs of infection, you should start a course of full-strength, broad-spectrum, antibiotics straight away. This is in addition to taking regular low dose penicillin (or similar). You should then get medical advice quickly.
Most feverish illnesses that you have will be common coughs and colds due to virus infections. These are not serious, and will be cleared by your immune system. The antibiotic will, in hindsight, usually not have been necessary. However, some serious infections start with symptoms similar to a cold. They can then develop quickly if you do not have a working spleen. So, it is best to 'play safe' and take a course of full-strength broad-spectrum antibiotics as soon as any feverish illness starts.
Travelling Abroad?
You are more likely to 'catch' malaria and meningitis if you do not have a working spleen. It may be best to avoid any countries where these illnesses are common. Do you really need to go? If you do travel, make sure you are fully immunised. Also, obtain up to date information about protecting against the type of malaria in the country you are to visit. This will include taking tablets to prevent malaria, and using mosquito nets, insect repellents, etc. Take the anti-malarial tablets exactly as advised for maximum protection.
Also, take a course of broad-spectrum antibiotics with you. Contact your doctor before travelling. A change to a different regular antibiotic for the duration of the trip may also be advised, depending on which country you visit. This is because in some countries (eg Spain) there is a high resistance to penicillin by some bacteria.
Other general advice
Animal and tick bites carry a risk of infection getting into the bloodstream. Take a course of full-strength broad-spectrum antibiotics after a bite, no matter how trivial. Also, consult a doctor.
Consider carrying a card or wearing a special bracelet or necklet which says that you do not have a working spleen. This would alert a doctor to take rapid action if you are seriously ill and cannot tell him or her yourself.
You can buy special bracelets and necklets from:
MedicAlert Foundation, 12 Bridge Wharf, 156 Caledonian Road, London, N1 9UU
MedicAlert Foundation, 12 Bridge Wharf, 156 Caledonian Road, London, N1 9UU
Tel: 0800 581420 Web: www.medicalert.co.uk
© EMIS and PIP 2006 Updated: June 2006
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