Spleen health

The spleen is located on the left side of the abdomen, underneath the ribs. The spleen filters the blood and removes abnormal cells (such as old and defective red blood cells) and makes disease-fighting components of the immune system (including antibodies and lymphocytes).

Since the spleen is involved in so many bodily functions, it can be at risk of a wide range of disorders. However, the human body adapts well to life without this organ, so surgically removing a diseased or damaged spleen is possible without causing any serious harm to the person.

Some of the disorders that can affect the spleen include:

• splenomegaly (enlarged spleen)
• blood disorders
• cancers – solid organ, blood
• cysts and tumours
• CAS, Congenital absence of the spleen
• hyposplenism.

The surgical removal of the spleen is called a splenectomy. The body can cope without the spleen, although the person is more at risk of bacterial infections after the operation.

Hyposplenism refers to a non-functioning spleen. It can result from various conditions, or some people can be born without a spleen; this is known as congenital asplenia. It can be diagnosed by blood tests and scans to check spleen function.

People who have had their spleen removed or who have a non-functioning spleen are at increased risk of bacterial infections, especially pneumococcal and meningococcal infections. In rare cases, these infections can become quite serious (sepsis) if healthcare is not accessed early.

To help protect from these diseases, the below vaccines are recommended and they should be discussed with a doctor. They are:

• pneumococcal vaccines
• meningococcal vaccines
• haemophilus influenzae type b vaccine 

These vaccines are available for free under the National Immunisation Program (NIP). They can be accessed through your GP, Aboriginal Medical Services, community health immunisation clinic or a community pharmacist who can administer vaccines.

People without a spleen are not at increased risk of contracting viral infections such as the flu (influenza) and COVID-19. However, if you do get a virus, you have an increased risk of getting a secondary bacterial infection.

People without a spleen are encouraged to have the annual flu vaccine and COVID-19 vaccines as per national guidelines.

If you have your spleen removed, you may be prescribed some low dose antibiotics, usually a penicillin-based antibiotic. They work to protect you from some bacterial infections. These can be prescribed for three years following a splenectomy, or lifelong, depending on your medical history.

People who are otherwise severely immunocompromised (having cancer, taking high dose steroids, HIV, organ transplants etc.) are recommended by their specialist to take them lifelong.

It is recommended you see a specialist immunologist if you have a penicillin allergy so this can be reviewed under supervised conditions.

Penicillin is one of the most important antibiotics for treating infections in people with a non-functioning spleen.

Emergency antibiotics

These are prescribed in case you feel very unwell and cannot immediately be seen by a doctor (either a GP or at a hospital emergency department). If you do take your emergency antibiotics, it is important to still seek medical attention as soon as possible.

Be alert, not alarmed post splenectomy. The most important thing to watch out for are any signs or symptoms of infection:

• Fevers
• Vomiting/Diarrhoea
• Shivers/sweats/shakes
• Confusion
• Severe headaches
• “Feeling very unwell”

If you experience these symptoms, seek medical attention immediately (GP or hospital emergency department). If you know medical attention will be delayed (over 1-2 hours), take your prescribed emergency antibiotics then seek medical attention as soon as possible.

People without functioning spleens can get very sick, very quickly so it is very important to watch out for these symptoms. Taking antibiotics early can prevent an unnecessary hospital stay.

Always tell your GP if you don’t have a spleen or its not working and use your medical alert card or emergency alerts on your phone.

Dogs and cats have bacteria living harmlessly in their mouth and under their claws. These bacteria can be harmful for people without a spleen.

If you get bitten or scratched, immediately wash the area with an antiseptic or soap and monitor for any signs of infection (redness, swelling).

Seek medical attention if you suspect an infection.

See a travel doctor before going overseas. There are some countries where malaria is common. Malaria spreads from humans via mosquitoes so make sure to use of mosquito repellent, barrier clothing and take prophylactic anti-malarial medication.

Always travel with your daily antibiotics (if you take them) and very importantly a supply of emergency antibiotics. Seek immediate medical attention if unwell.

When travelling by plane or sitting for extended periods, make sure to stand up regularly. Evidence suggests that individuals with a non-functioning spleen may have a slightly higher risk of blood clots. If you're unable to walk, try performing foot pumps and ankle circles to reduce the risk of deep vein thrombosis (DVT).