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Splenectomy and the asplenic patient
Splenectomy is done mainly for trauma with instability, refractory ITP and selected blood diseases; after it the patient is exposed to severe infection by encapsulated bacteria, so they are vaccinated and taught that fever is an emergency.
Why it matters in the exam
The exam asks about indications: trauma with non-responding instability, ITP that has failed medical treatment, hereditary spherocytosis with significant haemolysis, an enlarged spleen with cytopenias (hypersplenism), splenic abscess and tumours. The laparoscopic approach is usually preferred, and during it accessory spleens are sought, because a remaining accessory spleen is a cause of ITP relapse after splenectomy.
The second and more important part is life after splenectomy: vaccination against pneumococcus, meningococcus (ACWY and B) and Haemophilus influenzae type b — at least two weeks before elective surgery, or two weeks after emergency surgery; annual influenza vaccine; and teaching the patient that any fever is an emergency. Overwhelming post-splenectomy infection (OPSI) progresses rapidly to sepsis and disseminated intravascular coagulation, so antibiotics are given at once, even before work-up. The blood film shows Howell–Jolly bodies and sometimes a transient rise in platelets. In splenic trauma in a stable patient the spleen is preserved where possible, especially in children.
Key points
- Indications: trauma with instability, failed ITP, spherocytosis, hypersplenism, abscess.
- Vaccines: pneumococcus, meningococcus, Haemophilus — two weeks before elective or after emergency surgery.
- OPSI — fever is an emergency; immediate antibiotics.
- After splenectomy: Howell–Jolly bodies and raised platelets.
- ITP relapse — look for an accessory spleen.
Summary table
| Topic | Details | Exam note |
|---|---|---|
| Main indications | Trauma with instability, failed ITP, hereditary spherocytosis, hypersplenism, abscess, tumour | Laparoscopic approach for most elective operations |
| Vaccines | Pneumococcus, meningococcus (ACWY and B), Haemophilus influenzae type b, annual influenza | At least two weeks before elective surgery, or two weeks after emergency surgery |
| OPSI | Fever rapidly progressing to sepsis and intravascular coagulation | Immediate antibiotics (for example ceftriaxone) before work-up |
| Blood findings after splenectomy | Howell–Jolly bodies, raised platelets | Marked thrombocytosis — consider aspirin |
| ITP relapse after splenectomy | Platelets fall again, no Howell–Jolly bodies | Look for an accessory spleen |
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Sources
- CDC/ACIP Adult and Child Immunization Schedules, 2025 — Vaccination of persons with asplenia
- ASH Guidelines for immune thrombocytopenia, 2019 — Second-line treatment including splenectomy
- Sabiston Textbook of Surgery, 21st edition (2022) — The Spleen
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.