Patient education: Preventing infection in people with impaired spleen function (Beyond the Basics)

INTRODUCTION — The spleen is an organ that is important for controlling infection. People with impaired spleen function are at higher risk of severe infections. This includes people who:

●Do not have a spleen, either because they were born without one or because it has been removed (with a surgery called "splenectomy")

●Have a spleen that does not work properly, which can happen with certain medical conditions (for example, sickle cell disease)

If you have impaired spleen function, your increased risk of infection is lifelong. Fortunately, there are many ways to help reduce this risk. It is very important to learn about your condition and what you can do to stay healthy. People with greater knowledge have lower rates of severe infections.

This article will discuss how the spleen works, ways to help prevent infection, and what to do if you think you have an infection.

WHAT IS THE SPLEEN? — The spleen is an organ located in the upper left side of the abdomen. It filters bacteria and other germs from the bloodstream and is important for fighting infection (figure 1).

RISK OF INFECTION — People who have had their spleen removed, people who were born without a spleen, or people whose spleen does not work properly (due to conditions such as sickle cell disease or other blood disorders) are at increased risk for infections. The risk of infection is lifelong. It is highest in young children, older adults, and people with other problems with their immune systems.

In people with impaired spleen function, even minor infections can sometimes lead to a serious problem called sepsis. Sepsis is a serious and potentially life-threatening illness that happens when an infection spreads through the whole body. This is why it's so important to take measures to prevent infections and treat them immediately if they happen.

IMPORTANT INFECTIONS — The bacteria that most often lead to sepsis in this setting are Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus), and Haemophilus influenzae. These bacteria are common, and completely avoiding them is difficult. Fortunately, there are vaccines available to help prevent infection with these bacteria. (See 'Vaccinations' below.)

You should also be aware of other infections that can be very severe in patients whose spleens don't work well. These include malaria (an infection you can get from mosquitos in the tropics), babesiosis (an infection you can get from tick bites), and Capnocytophaga canimorsus infection, which you can get from animal (especially dog) bites or scratches. These infections and what you can do to avoid them are discussed below. (See 'Travel planning' below and 'Animal bites and exposures' below.)

PREVENTING INFECTIONS — If you do not have a spleen or if your spleen does not function properly, you should:

●Get all your vaccinations when your doctor recommends them.

●Make an emergency plan with your doctor about what to do if you develop a fever or other signs of infection.

●Keep a supply of antibiotics with you at all times.

●Know when to seek medical advice.

●Wear an alert bracelet or carry an alert card.

●Let your friends and family know that your spleen doesn't work properly (or you don't have a spleen).

Vaccinations — Vaccines are a very important and effective way to help prevent infection. This is true for everyone, but it is particularly important for people with impaired spleen function. While you should receive all recommended vaccinations, several that are particularly important are:

●Pneumococcal vaccine (two different vaccines may be needed depending on the vaccine type selected)

●Haemophilus influenza type b vaccine (one vaccine)

●Meningococcal vaccine (two different vaccines; repeat shots may be needed)

●Influenza vaccine (every year)

●Coronavirus disease 2019 (COVID-19) vaccine series

If you are having your spleen surgically removed (a splenectomy), you should get the above vaccines at least two weeks before your surgery (when possible). If you were not able to get these vaccines before surgery, you should get them about two weeks after surgery.

If your spleen does not work well for other reasons, you should review your vaccination history with your doctor and get the vaccines you need as soon as possible. You will also need to work with your doctor to make sure that you keep your vaccines up to date over time. For children, the recommendations for when to get each vaccine depends on age and vaccination history. (See "Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)" and "Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)" and "Patient education: Vaccines for adults (Beyond the Basics)".)

Emergency plan — It is important to recognize the early symptoms of infection if your spleen does not work well. Certain infections can progress very quickly, and you should make an emergency plan with your doctor about what to do if these symptoms occur.

Important signs of infection — Most people with impaired spleen function develop a written emergency plan with their doctor to keep a supply of emergency antibiotics with them at all times (see 'Emergency antibiotic supply' below).

Your doctor will give you instructions about what to do if you have signs of an infection. This may include taking a single dose of your antibiotic and going to the nearest medical facility IMMEDIATELY if you have:

●Fever (temperature greater than 101ºF or 38.3ºC)

●Uncontrollable chills and/or shivering

The written emergency plan will likely advise you to take a dose of your antibiotic immediately and go to the nearest medical facility for evaluation. Notifying your doctor at the start of illness should help to coordinate immediate emergency ward evaluation and treatment. You should also let your doctor know IMMEDIATELY if you have any of the below symptoms, which may also be caused by an infection. Symptoms that should prompt an immediate call to your doctor include:

●Severe or unusual headache

●Drowsiness, confusion, and/or disorientation

●Nausea, vomiting, and/or diarrhea

●Severe abdominal pain

●Pinpoint purplish red spots on the skin (petechiae) or larger bluish bruises

●Feeling lightheaded or passing out

●Feeling like your heart is racing

Other symptoms to be aware of include low-grade fevers, cough, sinus pain, any headaches, and ear pain. You may not need to take an antibiotic or go to the nearest medical facility right away if you have these symptoms, but you should call your doctor for advice as they could be signs that you are developing an infection.

Emergency antibiotic supply — If your spleen has been removed or does not function properly, your doctor should give you an emergency supply of antibiotics. Ideally, you should keep this supply with you at all times (eg, in a purse or briefcase) so that you can take a dose in case of illness. You should be sure that these antibiotics are always current (not expired).

Daily antibiotics — If you have your spleen removed, your doctor may recommend taking an antibiotic every day for one year to reduce the chance of infection. In certain (but not all) situations, doctors recommend continuing daily antibiotics for a longer period. This includes people who are at very high risk of infection, such as:

●Young children (usually under five years old)

●People who have had recurrent severe infections in the past

●People who have additional problems with their immune system

Because daily antibiotic use also comes with possible side effects, the decision to use daily antibiotics is generally made on an individual basis. If your health care provider thinks you should take daily antibiotics, he or she can talk with you about the risks and benefits.

Seeking medical advice — There are certain situations in which you should ask your health care provider for advice or instructions.

Animal bites and exposures — Animal bites and scratches, especially from dogs, can lead to serious and even fatal infection with a bacteria called Capnocytophaga canimorsus in people with impaired spleen function. If you are bitten or scratched by an animal, you should call your doctor. In most cases, you will be advised to take a dose of your emergency antibiotic supply and go to the nearest medical facility for evaluation. (See "Patient education: Animal and human bites (Beyond the Basics)".)

Ticks bites (particularly if you are in coastal New England, the mid-Atlantic states, or the Upper Midwest) can transmit an infection called babesiosis. Babesiosis is a parasitic infection that can be very severe in people whose spleen does not function well. If you get a tick bite, you should let your doctor know right away.

Measures to avoid tick bites and steps to take after a tick bite are described in detail in a separate topic review. (See "Patient education: What to do after a tick bite to prevent Lyme disease (Beyond the Basics)" and "Patient education: Lyme disease treatment (Beyond the Basics)".)

Travel planning — Before traveling abroad (particularly to tropical regions of the world where there is malaria), people with impaired spleen function should consult their health care provider or a travel medicine center (at least 4 to 12 weeks before travel). In some cases, additional vaccinations will be recommended; one or more medications may also be prescribed to prevent or treat certain travel-related infectious diseases. (See "Patient education: General travel advice (Beyond the Basics)".)

Informing others of your condition — Informing others that your spleen does not work properly (or you don't have a spleen) and that you are at increased risk for certain infections can help you get proper medical care, especially during an emergency.

Family, friends, and health care providers — Inform all of your doctors, dentists, and members of your health care team that your spleen has been removed or does not work properly. This is particularly important when you are seeing a new provider in an urgent care setting or emergency department.

Let your friends and family know about your condition too. In case of an emergency, this knowledge may be helpful.

Alert cards and bracelets — Carry a patient identification card, a Medic Alert bracelet or necklace, or other medical identification indicating that your spleen has been removed or does not work properly. Listing any medication allergies on your card or bracelet is also important.

WHERE TO GET MORE INFORMATION — Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for health care professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Splenectomy (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Vaccines for infants and children age 0 to 6 years (Beyond the Basics)
Patient education: Vaccines for children age 7 to 18 years (Beyond the Basics)
Patient education: Vaccines for adults (Beyond the Basics)
Patient education: Pneumonia in adults (Beyond the Basics)
Patient education: Influenza symptoms and treatment (Beyond the Basics)
Patient education: General travel advice (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Splenomegaly and other splenic disorders in adults
Assessing antibody function as part of an immunologic evaluation
Clinical features, evaluation, and management of fever in patients with impaired splenic function
Prevention of infection in patients with impaired splenic function

The following organizations also provide reliable health information.

●National Library of Medicine

     (www.nlm.nih.gov/medlineplus/ency/article/002944.htm, available in Spanish)

●Children's Hospital of Boston

     (https://www.childrenshospital.org/treatments/splenectomy)

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