Understanding How to Keep Yourself Safe Without a Spleen

You might not think of your spleen that much, but it’s been looking out for you. If you don’t have one, there are some things to know to keep yourself safe from infections.

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What Does Your Spleen Do?

Your spleen, a flat 4-inch organ located on the left side of your rib cage, is a part of your blood system and immune system. It works as a blood filter. It removes old red blood cells and holds on to a reserve of other red blood cells to release in an emergency, plus it helps recycle iron.

Another function of your spleen is that cells there can make antibodies to remove bacteria and any other cells that become coated in antibodies. This last bit helps keep our bodies free from pathogens.

Logically, if we don’t have this organ, we’re more vulnerable to bacteria, especially a category of bacteria called encapsulated bacteria due to a special carbohydrate (specifically a polysaccharide) capsule surrounding them. How could you lose your spleen, though?

Causes of Loss of the Spleen

There are three main reasons why people don’t have their spleen:

• Accident or trauma
• Sickle cell disease auto-splenectomy
• Treatment of another disease

Trauma

The most common reason for having your spleen removed surgically is trauma. This is usually due to car and motorcycle accidents as well as falls, fights, and sports injuries.

In car accidents, such injuries can also be associated with the incorrect placement and use of a seatbelt. There can also be cases of stabbings and gunshots that can injure the spleen but this less common.

The spleen is the most commonly injured organ in blunt abdominal trauma.

Not all damage to the spleen requires surgery. Surgeons will often watch to see how the person and damage progresses, if it is not an emergency, before deciding to go to surgery.

Sickle Cell Disease

Autosplenectomy happens in sickle cell disease when the misshapen cells block the blood flow to the spleen, causing scarring and eventual atrophy of the organ.  In the United States, approximately 100,000 people have sickle cell. Around the world, over a million do. There are different types of sickle cell disease. The differences in these types depend on which genetic mutations are present.

The loss of the spleen occurs most commonly in the most common type of sickle cell—hemoglobin SS disease. Hemoglobin SS disease results from having two copies of the same hemoglobin S gene mutation.

In this type, people usually lose their spleen by a process called “autosplenectomy.” There have been rare cases of other diseases causing the same process.

Removal to Treat Disease

People have had their spleens removed to manage an illness, especially an autoimmune illness. Splenectomy is used to treat one rare disease in particular—immune thrombocytopenic purpura (ITP).

In ITP, the immune system, unfortunately, attacks platelets. This means our bodies don’t have one of the tools they need for clotting to stop bleeding. Those affected by the immune system going awry like this may have bruises and bleed easily. They may also have pinpoint red spots on their legs.

This disease can go away on its own, but some need medications. If it doesn’t go away and the medications aren’t enough, sometimes removing the spleen is the intervention that helps.

There are a number of different disorders like hereditary spherocytosis or autoimmune hemolytic anemia (AIHA) where there is anemia due to the destruction of red blood cells. Splenectomy can sometimes, but not always, stop the breakdown of red blood cells when medications or other treatments do not work.

Although less common, some have had splenectomies to treat thalassemia as well as thrombotic thrombocytopenic purpura (TTP). Sometimes splenectomies were done because a spleen had become too large from another disease. It was also carried out at times to stage diagnosis of Hodgkin lymphoma in order to decide the best treatment.

About 22,000 people lose their spleen through surgery each year in the U.S.

Splenectomy Surgery

The surgery to remove your spleen is called a splenectomy. In the U.S., it is usually done with laparoscopically (with a camera and a few very small incisions). If you’re healthy, you could leave the hospital on the same day and be fully recovered in two weeks.

Vaccinations to Prevent Infection

People who have no spleens are more likely to get sick from certain types of bacteria, particularly encapsulated bacteria (bacteria that have a thick outer carbohydrate covering). You should be vaccinated before you have surgery if it is planned surgery.

Not everyone who needs a splenectomy needs vaccines, but if you do, you should have the vaccines two weeks before a planned surgery. Many splenectomies are performed as emergencies after trauma and so advanced planning is not always possible.

If you had emergency surgery and couldn’t be vaccinated beforehand (or the vaccinations were not done before surgery for another reason), you should be vaccinated afterward. The vaccines should be given two weeks or more after surgery, but don’t wait too long.

Vaccines Needed for Splenectomy Patients

There are four things you should get vaccines against:

• Neisseria meningitidis
• Haemophilus influenzae type B
• Streptococcus pneumoniae
• Influenza

You should also be vaccinated against all of the diseases you’d normally be vaccinated against, like measles, mumps, rubella, varicella, and tetanus. You should also talk to your healthcare provider about whether you need to be revaccinated or need a different version of one of these vaccines.

Meningococcal Vaccine

Neisseria meningitidis (N. meningitidis) is the bacteria that can cause meningitis and/or sepsis. The main vaccine is quadrivalent. It protects against four strains of N. meningitidis (Serogroups A, C, W-135, and Y).

It leaves B uncovered if not specifically vaccinated for. Serogroup X is less common and does not yet have a vaccine available.

Hib Vaccine

Haemophilus influenzae type b (Hib) bacteria used to be the top cause of bacterial meningitis in kids under 5 until the vaccine started to be used. It also causes pneumonia and throat swelling and infections that can be serious. It’s largely an infection in children, but anyone without a spleen should be vaccinated.

Pneumococcal Vaccine

There are many types of Streptococcus pneumoniae (Strep pneumo). Which strain you’re protected against depends on which vaccine you receive.

 Prevnar 13 (PCV 13) protects against 13 strains and has replaced Prevnar 7, which protected against seven strains. Vaxneuvance (PCV15) protects against 15 S. pneumoniae serotypes, while Prevnar 20 (PCV20) helps prevent infection caused by 20 of the most severe types of S. pneumoniae. The polysaccharide vaccine Pneumovax 23 (PPSV23) protects against 23 strains.

Which vaccine you receive will depend on consultation with your healthcare provider, as they are indicated for different age groups and depend on underlying conditions as well as previous vaccination history.

Influenza Vaccine

You’ll need to get the influenza vaccine every year. It is to protect you from the secondary bacterial infections, like those that cause pneumonia, which you’re at risk for if you get sick with the flu. Influenza deaths can occur because the lung’s immune defenses are breached and exhausted by the virus, allowing a fatal bacterial infection.

Prophylactic Antibiotics

Some people without a spleen, especially children, take particular antibiotics daily at their healthcare provider’s request. The pros and cons of this should be discussed with your healthcare provider or other health professional.

Taking antibiotics regularly can have unintended consequences. You can develop antibiotic resistance or get infections that occur when our regular old bacteria are wiped out and left unchecked, so it’s important to talk to a medical professional about this.

Others carry antibiotics with them which they take immediately if they develop a fever or become sick. They then seek medical care immediately. Immediate treatment can help prevent an infection from becoming a deadly case of sepsis.

Dog or Cat Bite Infection

Another risk for serious infection comes from a bacteria called Capnocytophagia. It’s a rare cause of infections in people with spleens but can be a very serious infection in someone without a spleen. It is usually due to a dog bite, though occasionally cat bites as well.

Symptoms begin usually in one day, so you should be prepared in case of a dog bite to seek medical attention (and potentially take antibiotics like penicillin and other common antibiotics that can treat the infection).

Preventing Travel Risks

If you’re traveling you may encounter germs you wouldn’t otherwise. You may also live somewhere that has different infectious agents than other places do. There are particular infections that you may be at more risk for following loss of your spleen.

If traveling in West Africa, be sure to be vaccinated against meningococcal meningitis and that the vaccines are up to date. (Vaccine protection doesn’t always last as long as we’d like.) Likewise, the pneumococcal vaccine does not cover all strains and you may be exposed to a different strain when you’re away.

You also may be at more risk for a serious case of malaria if you don’t have a spleen. Be sure to have malaria prophylaxis if traveling where you might be at risk and be extra careful to avoid mosquitoes.

Likewise, if you live or travel to areas where the Babesia parasite is found, you would be at greater risk without a spleen. This would especially be on Nantucket or Martha’s Vineyard in Massachusetts, but also Block Island off Rhode Island and Shelter Island, Fire Island, and eastern Long Island—all part of New York State.

The Babesia parasite can occur in other parts of these states and in other areas of the Northeast and the upper Midwest, including New Jersey, Wisconsin, and Minnesota. There are also rare (and serious) cases from Europe. Babesia can also be transmitted by a blood transfusion.

Also, some without a spleen may be more prone to having a deep vein thrombosis or another clot, including when they travel on a long plane flight or ride. If you’re going to fly, talk to your healthcare provider about this disorder and any risks you may face.

Prognosis After Spleen Loss

Scientists looked back at the soldiers who lost their spleens in World War II. They found that of the 740 American servicemen tracked that many lived long lives.

However, they did have increased mortality due to pneumonia (possibly Strep pneumo infections) and ischemic heart disease (heart attacks, possibly because removing their spleens affected their blood system and caused them to clot more, which is a known non-infectious side effect).

Enlarged Spleen

Having a big spleen is called splenomegaly. It’s something a healthcare provider should check out. There are many reasons why a spleen might become enlarged. One of the most common is mononucleosis (mono) caused by the Epstein Barr virus (EBV).

There are those who have large spleens due to blood conditions they were born with, like thalassemia or sarcoid. Others have a large spleen because of lymphoma or leukemia (blood cancer) or a hemolytic anemia (where red blood cells are destroyed). Others develop it from having liver disease (like portal hypertension).

Having More Than One Spleen

Some people have more than one spleen. Some are born with polysplenia (or multiple spleens) which may be related to other congenital conditions (or medical problems at birth).

Others end up with a little bit of their spleen separated from the rest; this is often an “accessory spleen” that results from trauma (including from surgery, even from a splenectomy).