CancerGuide: Important Warning to Anyone Without a Spleen

Asplenia: Living Without a Spleen

Below is an explanation of the effects of asplenia (a– means without, and –splenia means spleen) plus guidelines for people to follow if they do not have a spleen. Much of this article is taken from the ACE (After the Cancer Experience) Young Adult Program of the University of Texas:

As part of your cancer treatment, your spleen was removed. The spleen is an organ about 5 inches long and 3 inches wide that is in the abdomen under the left rib cage. The spleen carries out a number of important functions but is not necessary for life. Thus the spleen can be removed but it takes away some of the body’s functions. The most important function of the spleen is to help the body fight off infection, especially certain bacteria.

Because you do not have a spleen, you are at risk for infections from these bacteria. Infection can be very rapid, within hours, and may lead to death or serious impairment. For this reason it is very important that you understand how to lower your risk.

Letting the physician or nurse know that you do not have a spleen is one of the most important things to remember about your medical history. It’s a good idea to make a laminated card to keep in your wallet or purse to tell medical personnel what to watch out for. This should be presented any time you go to a medical facility for care.

Below are several recommendations:

1. If you have a fever of 100.4 degrees F (38.0 C) or any sign of an infection, you need to see a physician, nurse practitioner, or physician assistant that day.

2. You are at risk from the infections listed below. Not all physicians are aware of all of the different organisms, so you should put this info on your laminated card.

  • Streptococcus pneumoniae — a common bacteria that can cause ear infections, pneumonia, meningitis, and sepsis (blood infection)
  • Hemophilus influenzae
  • Neisseria meningitidis
  • Escherichia coli
  • Malaria — important to remember when traveling outside the US
  • Capnocytophaga canimorsus — an infection associated with dog bites
  • Babesiosis — a rare tick-borne infection

3. What about antibiotics? The data is strong enough to recommend that children should receive daily penicillin (or if allergic, erythromycin). We do not have enough data to recommend what adults should do. Based on the information available, ACE recommends one of two options:

  • Option A. Antibiotic every day — Penicillin (Pen VK 250 mg twice a day); or if allergic to penicillin, use erythromycin.The advantage to this approach is that if you are exposed to the most common bacteria (Streptococcus pneumoniae), you are more likely to fight off the infection. A disadvantage is that you have to remember to take the antibiotic twice every day. Also, we do not know the long-term chance of developing a bacteria resistant to penicillin or erythromycin. In spite of this, the ACE program recommends daily use of penicillin or erythromycin as the better approach.
  • Option B. Antibiotic at the first sign of infection — Penicillin or erythromycinYou must keep a supply of antibiotics available to you at all times. If you develop an infection from Streptococcus pneumoniae, starting the antibiotic early can lower the risk of problems, though not as much as the first option. The advantage of this approach is not having to remember to take the medication each day. A problem is that people often forget where they placed the antibiotic and cannot find it when it’s needed.** It is very important to realize that you still need to see a physician or other healthcare provider promptly for any sign of infection or fever.

4. Wear a Medic Alert bracelet or necklace indicating that you do not have a spleen.

American Medical Identifications
(800) 363-5985
949 Wakefield, Suite 100, Houston, TX 77018

5. Recommended vaccinations: (Please note that vaccinations do not provide complete protection! They help, but you still can have the problem they aim to prevent.)

  • Influenza (flu) vaccine each year
  • Hemophilus influenzae vaccine (Hib vaccination)
  • Meningococcal vaccine if traveling outside of the US into an area with Neisseria meningitidis
  • Pneumonia vaccine for you and family members living with you

If going into an area with malaria:

You need to take a medication to prevent infection with malaria (depending on area of travel) and use mosquito/insect repellent with DEET. Try not to visit areas where malaria is epidemic.

7. If you are bitten by a dog:
You may become infected with Capnocytophaga canimorsus. You need to be treated with an antibiotic such as Augmentin for at least five days.

8. If you develop a bacterial infection despite these precautions, you must receive medical treatment immediately in the hospital.