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Spleen Problems in Childhood Cancer Survivors

Certain cancer treatments may damage or affect the function of the spleen, an important part of the body’s immune system.

If your spleen was removed as part of treatment or does not work properly, you are at increased risk for developing a serious infection.

It is important for you to take steps to prevent infection.

You should seek medical help if you develop signs of an infection. An infection can be life-threatening if not treated immediately.

How Does the Spleen Work?

A graphic of the spleen, with the left view showing the outside and the right view showing a cross section. In the cross section, there are labels for the capsule, trabecula, vascular sinusoid, and white pulp.

The spleen is in the upper left part of the abdomen, just under the rib cage. It is about the size of a fist.

The spleen produces white blood cells that help the body fight infections. White blood cells make antibodies, specialized proteins that fight infections.

The spleen also works as a filter to remove bacteria, viruses, and other foreign substances from the blood.

The spleen is part of the lymphatic system. The lymphatic system is a network of nodes, glands, and vessels that transports white blood cells through the body to fight infection.

Cancer Treatments that May Cause Spleen Problems

  • Surgical removal of the spleen (splenectomy)
  • High doses of radiation to the abdomen (at least 40 Gy)
  • Active chronic graft-versus-host disease as a result of a hematopoietic cell transplant (also known as bone marrow or stem cell transplant)
This illustration shows a boy with organs of the lymphatic system labeled: Cervical nodes, lymph vessels, axillary nodes, inguinal nodes, spleen, thymus, and tonsils.

The spleen is part of the lymphatic system. The lymphatic system is a network of nodes, glands, and vessels that transports white blood cells through the body to fight infection.

Conditions that May Occur if the Spleen Doesn’t Function

If your spleen doesn’t function or work properly, you are at risk for infection.

The types of infections most likely to occur in people without a functioning spleen are caused by encapsulated bacteria. These bacteria have an outer coating that shields them from the immune system. 

Common types include Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitis.

These bacteria can cause different types of illnesses from mild to severe.

  1. Illnesses caused by Streptococcus pneumoniae are known as pneumococcal disease.

    These include illnesses such as pneumonia, ear infections, sinus infections, meningitis, and bacteremia.

    There are vaccines to prevent pneumococcal disease. For more information, visit the Centers for Disease Control (CDC) page on Pneumococcal Disease (Streptococcus pneumoniae).

  2. Haemophilus influenzae bacteria causes illnesses that range from mild ear infections to serious bloodstream illnesses.

    H. influenzae do not cause influenza.

    A vaccine can prevent one type of H. influenzae (type b or Hib) disease.

    The CDC recommends Hib vaccination for all children younger than 2 years old.

    For more information, visit the CDC page About Haemophilus influenzae Disease.

  3. Neisseria meningitis is also known as meningococcus.

    Meningococcal illnesses can be very serious. They include infections of the lining of the brain and spinal cord and bloodstream infections.

    There are 2 types of meningococcal vaccines available in the United States.

    For more information, visit the CDC page on Meningococcal Disease.

Signs and Symptoms of an Infection

  • Fever
  • Tiredness
  • Aching muscles
  • Chills
  • Headaches
  • Vomiting
  • Diarrhea
  • Abdominal pain

Contact your health care provider if you have these symptoms even if you don’t have a fever.

Delaying a medical visit can be dangerous because bacterial infections can get worse quickly.

Whenever you have a fever, you must be treated with antibiotics as if you had a serious infection.

A blood culture will likely be performed to help find the source of the infection. It can take few hours to a few days for the results.

What Cancer Survivors Can Do for Spleen Problems

Know Your Risk and Monitor Your Health

  • Know your risk of spleen problems. Ask your doctor if you received treatments that increase your risk.
  • Share a copy of your Survivorship Care Plan with health care providers. It includes details about your cancer treatment and health problems that may occur because of your treatment.

Prevent Infections

An important way to deal with infections is to prevent getting them in the first place.

Vaccines

Vaccines may reduce the chances of a serious infection.

The Children’s Oncology Group (COG) recommends these vaccinations:

  • Pneumococcal
  • Meningococcal
  • HIB (Haemophilus influenzae type B)

Check with your health care provider to see if you need any of these vaccines.

COG also recommends getting an influenza (flu) vaccination each year. It is important to remember that even with vaccinations, people are still at risk for serious infections. Vaccines are not 100 percent effective.

Antibiotics

Some providers may prescribe a daily antibiotic like penicillin to reduce the chance of bacterial infection. Others may give a prescription for antibiotics to have on hand to take at the first sign of illness or when traveling to an area without adequate medical care. In some cases, antibiotics may be needed before planned procedures, such as dental work.

Animal/ Human Bites

Animal and human bites can result in serious bacterial infections.

Get immediate medical attention if bitten by an animal or human.

Ticks

Tick bites can cause infections. People without a functioning spleen are at increased risk for an infection caused by Babesia, a germ transmitted by deer ticks. (This is not the same germ that causes Lyme disease.)

If you receive a tick bite, remove the tick and contact your health care provider about what to do.

When going outdoors, wear protective clothing and use insect repellent to protect against ticks.

Malaria

If you travel to countries where malaria is common, take special precautions to avoid getting it. Use insect repellants, netting, and protective clothing to prevent bites from mosquitos, which can spread the illness.

Before traveling to areas where malaria is common, ask your medical provider for a prescription for an anti-malaria medication.

Medical Alert Emblem

Wear a medical alert bracelet or necklace to alert health care providers that you do not have healthy spleen function in case you are unable to communicate in a medical emergency.

Carry a wallet card with guidelines for health care professionals. Visit the COG Health Link on Precautions for People Without a Functioning Spleen for a copy of a card.


Reviewed: May 2020