Life without a spleen: what you need to be aware of

People who have had their spleen removed are more prone to certain infections. In addition, these can be more difficult. A guideline recommends three specific vaccinations as protection

It weighs only 150 grams, lies behind the stomach and is not vital. The spleen usually only becomes noticeable when diseases cause it to swell or when it bleeds massively after an accident because a dense network of vessels is hidden behind the injured shell. For a long time, surgeons removed the organ without much concern. Today they are weighing more critically whether this is inevitable. Because a lack of the spleen can cause serious problems.

The organ has two main functions: it filters out old red blood cells and platelets, and it participates in the defense against pathogens. The focus is on encapsulated bacteria that can cause lung and brain infections, for example.

Increased risk of blood poisoning

If this protective function fails, people are more susceptible to infections with such pathogens.Worse still: the risk of the immune system derailing after an infection is significantly higher if there is no spleen. Between one and five percent of those affected suffer from sepsis, popularly known as blood poisoning. It is fatal in around half of all cases, and doctors have to amputate limbs for many survivors.

That doesn't have to be the case if the patients were to protect themselves better. But data from a study show that only a few people affected take additional vaccinations, reports Professor Frank Brunkhorst, one of the study directors. There are various reasons for this, explains the sepsis researcher from Jena University Hospital: "In the clinic, the vaccination is not paid for by the health insurers, and after discharge, the patients and their general practitioners often do not think about it. Also, booster vaccinations are usually neglected."

The spleen lies in the left upper abdomen, partly covered by the stomach

© W & B / Martina Ibelherr

Vaccinations against three pathogens recommended

The guidelines recommend three vaccinations in particular if the spleen is missing:

  • Protective syringes against pneumococci, meningococci and Haemophilus influenzae type b (Hib).
  • Annual immunization against influenza is also considered useful because influenza promotes an additional bacterial infection.

The most important thing is the vaccination against pneumococci: in the new study, these bacteria represent the majority of the germs that cause sepsis in people without a spleen. In a comparison group of sepsis patients with an intact spleen, they were the culprits in only about one in ten.

In order to counteract the lack of vaccination, experts have developed an identity card (free of charge, order form at asplenie-net.org/notfallpass). It should remind patients of vaccination appointments and sensitize doctors to the topic. Some clinics enclose the passport with the discharge letter to the family doctor.

Always see a doctor if you have a fever

Vaccinations, however, do not provide one hundred percent protection. Therefore, as a precaution, people without a spleen should consult a doctor as soon as possible for any infection associated with fever or other severe symptoms. The same applies after an animal bite. Because sepsis can develop very quickly.

For this reason, Frank Brunkhorst also recommends that patients get a prescription for an emergency antibiotic if a doctor cannot be reached within one to two hours. "In this way, for example, you can bridge the gap when traveling abroad." On the other hand, there is little data on the question of whether taking antibiotics can protect particularly vulnerable people as a precautionary measure.

Increased risk of blood clots

There is even more uncertainty about the second possible danger of removing a spleen, an increased risk of blood clots. Therefore, there are no official recommendations here. "We routinely examine the patient's blood after the operation and advise general practitioners to do the same if the number of platelets has risen too much after the operation," reports Dr. Oliver Haase, senior physician in charge of the clinic for general, visceral, vascular and thoracic surgery at the Charité in Berlin. If the platelet count remains high, you should consider taking acetylsalicylic acid. "I personally would take it too," says Haase.

Although the risk of sepsis is particularly high in the first few years after removal of the spleen, it still persists decades later. So there is no reason to let up with vaccination protection. After all, says Oliver Haase, "the knowledge about this danger is now spreading among all colleagues".