01Role and principlesWho benefits and the main preventive aims.
The spleen clears opsonised organisms and supports antibody responses. Risk is greatest in early years after splenectomy and in children, older adults, people with haematological malignancy or immune suppression and those with previous invasive infection, but it never returns to baseline. Prevention must remain visible long after surgical follow-up ends.
Vaccination is individualised from age, indication, previous doses and timing of surgery or immunosuppression. The UK Green Book provides current schedules for pneumococcal, meningococcal, Hib and influenza vaccination. Vaccines reduce but do not abolish risk, so antibiotic prophylaxis and emergency action remain important.
A usable plan tells the patient what to do at the first sign of fever, how to take rescue antibiotics, where to seek urgent care and how to communicate asplenia. It also covers malaria prevention, prompt treatment of dog or other animal bites and communication before travel. Primary care owns recalls and medication review after discharge.
Key points
- Loss of splenic function creates lifelong vulnerability to rapidly progressive infection, especially from encapsulated bacteria including pneumococcus, meningococcus and Haemophilus influenzae type b.
- Plan indicated vaccines at least 2 weeks before elective splenectomy when possible; if they were not given before emergency surgery, start them at least 2 weeks afterwards using the current Green Book product and interval schedule.
- Annual influenza vaccination reduces influenza and secondary bacterial risk; pneumococcal, meningococcal and Hib protection requires age, prior-dose and risk-based scheduling.
- Offer daily antibiotic prophylaxis for at least 2 years after splenectomy and continue lifelong in higher-risk groups after individual review; adherence, allergy, prior invasive infection and immune status need active reassessment.
- Provide an emergency oral antibiotic supply with written instructions, but make clear that taking it does not replace urgent medical assessment.
- Give a splenectomy card or medical alert, inform primary care and dental teams, and address travel malaria, animal bites and access to care abroad.
02Assessment and patient selectionRisk features, eligibility and important cautions.
Abrupt fever, rigors, vomiting, myalgia, confusion, mottling or shock may progress within hours even when no focal source is initially apparent.
Previous invasive pneumococcal disease, haematological malignancy, immune suppression, older age, poor vaccine response or unreliable access to care strengthens the case for extended prophylaxis.
Sickle-cell disease, coeliac disease and selected haematological or inflammatory conditions can impair splenic function without surgery and require condition-specific prevention review.
Dog and other mammalian bites can transmit Capnocytophaga and polymicrobial infection; early wound care and antibiotic assessment are especially important after splenectomy.
03Baseline assessmentMeasurements that guide the plan and track progress.
Read from the initial assessment onwards. Tests may run in parallel in urgent care; first-line, preferred, confirmatory, definitive and gold-standard labels appear only when the chapter explicitly states them.
- 01
Vaccination record reconciliationFirst step - Why
- Determine which risk-based vaccines and boosters have been received and when.
- Interpretation and limitations
- Do not infer protection from a generic 'vaccinated' entry. Product, date, age and immunosuppression timing determine the next dose.
- 02
Medication and allergy review - Why
- Confirm daily prophylaxis, rescue supply, adherence and a safe alternative when true immediate beta-lactam allergy exists.
- Interpretation and limitations
- A lapsed repeat prescription or expired rescue pack represents a prevention failure even when the patient is currently well.
- 03
Full blood count and blood film when hyposplenism is uncertain - Why
- Support assessment of haematological disease and absent splenic filtering.
- Interpretation and limitations
- Howell-Jolly bodies can support hyposplenism but absence does not reliably prove normal splenic immune function; interpret with the underlying diagnosis.
- 04
Immune-status review - Why
- Identify chemotherapy, transplantation, biological therapy or immunoglobulin deficiency that changes vaccine timing and expected response.
- Interpretation and limitations
- Coordinate vaccination with the responsible specialist because live vaccines and responses differ during significant immune suppression.
- 05
Travel risk assessment - Why
- Plan malaria prevention, vaccines, rescue access and medical documentation for destination and itinerary.
- Interpretation and limitations
- Asplenia increases severe malaria risk; mosquito avoidance and destination-specific chemoprophylaxis remain essential even after routine UK vaccines.
04InterventionsLifestyle, treatment and escalation options.
01Elective splenectomyBuild prevention before dischargeFirst stepSplenectomy is planned and there is time to review vaccination and education beforehand.+
- 1Reconcile vaccines and immune treatment, administer indicated products at least 2 weeks before surgery when feasible using the current Green Book schedule, and document products and doses precisely.
- 2Prescribe daily prophylaxis and an emergency supply with allergy, renal and interaction review; teach the difference between prevention, rescue dose and hospital treatment.
- 3Issue alert information, notify primary care, create recall dates and provide fever, bite and travel action plans before the operation.
02Emergency splenectomyRecover missed prevention safelyThe spleen is removed without preoperative vaccination or education.+
- 1Record asplenia prominently and stabilise the surgical illness; when vaccines were not given before surgery, plan the current risk-based products from at least 2 weeks postoperatively.
- 2Begin prophylaxis according to age and risk, supply emergency treatment and deliver written education before discharge with teach-back.
- 3Send a complete vaccine and medicine schedule to primary care and the responsible specialist, including boosters and review of lifelong risk.
03Febrile illnessTreat first symptoms as urgentAn asplenic or hyposplenic patient develops fever, rigors or sudden systemic illness.+
- 1Take the prescribed rescue antibiotic immediately if the personal plan says to do so and seek emergency medical assessment without waiting for response.
- 2At hospital perform ABCDE, obtain cultures promptly and give source-appropriate intravenous antimicrobials through the high-risk sepsis pathway.
- 3Review vaccination, prophylaxis adherence and source after recovery, replace the rescue supply and reinforce future action without blame.
05Medicines and treatment safetyRegimens, contraindications and review points.
Phenoxymethylpenicillin prophylaxis
A common adult prophylactic regimen is 250 mg orally twice daily, continued for the risk-based duration in local policy.Confirm adherence, renal considerations and allergy phenotype; breakthrough infection remains possible and fever still requires immediate rescue treatment and hospital assessment.
Erythromycin prophylaxis alternative
A common adult alternative is 500 mg orally twice daily when true immediate penicillin allergy prevents phenoxymethylpenicillin use.Check QT prolongation, electrolytes, liver disease and gastrointestinal tolerance. Erythromycin is a strong CYP3A4 inhibitor with important statin, antiarrhythmic and anticoagulant interactions; verify the allergy phenotype and local resistance before substitution.
Co-amoxiclav emergency oral supply
A common adult rescue plan is 625 mg orally three times daily for five days, started immediately while seeking emergency assessment.Use only when this exact personal plan has been prescribed; avoid in immediate penicillin allergy or previous co-amoxiclav-associated jaundice or hepatic dysfunction, adjust for renal impairment, keep the pack in date and never delay emergency assessment.
06Targets, monitoring and follow-upResponse, safety and longer-term review.
- Review vaccine products, dates and future boosters at every annual primary-care check and after any change in immune treatment.
- Confirm daily prophylaxis adherence, adverse effects, allergy accuracy and whether risk factors support continuation beyond the minimum period.
- Check that the rescue pack is in date, accompanies travel and has clear instructions understood by the patient and family.
- Maintain asplenia alerts in hospital, general-practice and patient-held records and include status in every transfer or discharge summary.
- After any febrile episode, invasive infection or animal bite, reassess the prevention plan, culture history and need for specialist advice.
07Special situationsVariants, exceptions and circumstances that change the usual approach.
Vaccines are incomplete protection
Encapsulated organisms include many serotypes, and immune response varies; vaccination never makes delayed fever assessment safe.
Risk persists for life
Although early postoperative years carry particular risk, overwhelming infection can occur decades later when records and patient awareness have faded.
Rescue means rescue then review
Taking the emergency antibiotic is the first step while travelling to care, not a home trial that determines whether symptoms are serious.
Bites need special attention
Capnocytophaga infection can progress rapidly after dog exposure in asplenia, so apparently minor bites warrant early wound and antimicrobial assessment.
08Common pitfallsFrequent interpretation and management errors.
- 01
Assuming routine childhood vaccines complete the adult asplenia schedule.
- 02
Allowing prophylaxis or the rescue pack to lapse after surgical follow-up ends.
- 03
Telling patients to wait for antibiotic response before seeking care.
- 04
Vaccinating without checking previous products, timing and immune suppression.
- 05
Forgetting malaria and animal-bite advice in a prevention consultation.