Table of ContentsView AllTable of ContentsSpleen FunctionCauses of LossVaccinationsProphylactic AntibioticsPreventing Travel RisksPrognosisEnlarged SpleenMultiple Spleens
Table of ContentsView All
View All
Table of Contents
Spleen Function
Causes of Loss
Vaccinations
Prophylactic Antibiotics
Preventing Travel Risks
Prognosis
Enlarged Spleen
Multiple Spleens
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 andimmune system. It works as a blood filter.It removes oldred blood cellsand 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?
The Function of the Spleen
Causes of Loss of the Spleen
There are three main reasons why people don’t have their spleen:
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.
What Is Sickle Cell Disease?
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).
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 orautoimmune hemolytic anemia(AIHA) where there isanemiadue 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 treatthalassemiaas 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 asplenectomy. In the U.S., it is usually done withlaparoscopically(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.
What to Expect With a Splenectomy Surgery
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 PatientsThere are four things you should get vaccines against:Neisseria meningitidisHaemophilus influenzae type BStreptococcus pneumoniaeInfluenza
Vaccines Needed for Splenectomy Patients
There are four things you should get vaccines against:Neisseria meningitidisHaemophilus influenzae type BStreptococcus pneumoniaeInfluenza
There are four things you should get vaccines against:
You should also bevaccinatedagainst 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 ofN. meningitidis(serogroups A, C, W, and Y).
It leaves B uncovered if not specifically vaccinated for. Serogroup X is less common and does not yet have a vaccine available.
Prevention of Meningitis
Hib Vaccine
Haemophilus influenzaetype 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.
An Overview of Haemophilus Influenzae Type B (Hib)
Pneumococcal Vaccine
There are many types ofStreptococcus pneumoniae(also called pneumococcus or strep pneumo). Which serotypes you’re protected against depends on which vaccine you receive.
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.
What Is Pneumococcal Meningitis?
Influenza Vaccine
Understanding Flu Vaccine Effectiveness
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 calledCapnocytophagia.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).
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 ofmalariaif 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 theBabesiaparasite 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.
Also, some without a spleen may be more prone to having adeep vein thrombosisor 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, 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).
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 ahemolytic anemia(where red blood cells are destroyed). Others develop it from having liver disease (likeportal 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).
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