In this article you can read about the importance of vaccinations if the spleen has been removed in connection with surgical procedures in the upper abdomen.
Its main role is to protect against infections and clear out dead cells. The spleen contains many different types of immune cells in large clusters called germinal centers. From there, these cells can be mobilized if an infection is underway in the body. You could say that the spleen is the body’s large immunological reserve pool.
Can you live without a spleen?
The spleen is an important, but not vital, organ. This means that it is possible to live without a spleen. The surgical removal of the spleen is called splenectomy.
The most common cause of splenectomy is physical trauma resulting in major bleeding. This is because the spleen is an organ that is very rich in blood vessels (vascularized), and this means that damage to the spleen can cause life-threatening bleeding. Another reason why the spleen may need to be removed, which many ‘laymen’ do not know about, is upper abdominal surgery. Because the spleen is in such close proximity to several organs, it usually needs to be removed if the stomach (gastrectomy) or pancreas (pancreatectomy) is to be removed.
Quite simply, the spleen ‘goes with the flow’. Therefore, it is very important that patients undergoing planned surgeries aiming at radical gastrectomy/pancreatectomy are aware of the consequences of not having a spleen.
Vaccination after splenectomy
If you have had your spleen removed, you will need to be vaccinated against two different bacteria, namely pneumococcus (Streptococcus pneumoniae) and meningococcus (Neisseria meningitidis).
Depending on your other immunological status, you may also need to be vaccinated against Haemophilus influenzae, which is a different type of bacteria. This is because the spleen is the organ in the body that contains immune cells that can fight infections from these bacteria. The bacteria are part of our normal flora, that is, they are present in our body without causing disease under normal circumstances. However, for people without spleens, both bacteria are really dangerous, as pneumococci can cause severe pneumonia and sepsis and meningococci can cause meningitis, which is life-threatening.
The Swedish Society of Infectious Diseases has published an article that aims to increase knowledge about vaccination after splenectomy. Unfortunately, there are no clear national guidelines, which means that the regions have different procedures. For example, some patients have been told that a single vaccination is enough for life, which is not the case. Some patients are already vaccinated in hospital after surgery, while others have to go and do it themselves. Unfortunately, there have even been examples of patients who were not informed at all that their spleen was gone and that they needed to be vaccinated.
Tips and advice for splenectomy patients
Knowledge about splenectomy is limited, especially in primary care. Therefore, the following advice is useful to follow as a patient:
- Ask your surgeon to give you information about a possible splenectomy during your planned surgery. You may need to be vaccinated in advance.
- Ask your surgeon to tell you if your spleen will be removed after surgery. If you have already had an operation (stomach/pancreas) and do not know if you still have your spleen, call the hospital to find out. It’s never too late to get vaccinated, but it’s optimal to start the vaccination within 14 days after surgery.
- If you don’t have a spleen and become ill with high fever and symptoms of infection, you must seek medical attention immediately. A splenectomy patient is considered immunosuppressed for the rest of their life, so a common flu, for example, can have a much more severe course than in a healthy person. In addition, vaccines do not protect against all types of pneumococci and meningococci, so you may still be infected by different subtypes of these bacteria. If you are being treated with chemotherapy and/or immunotherapy, this is an additional reason to seek care even for ‘normal’ symptoms.
