Spleen Problems and Splenectomy

Children with cancer or blood disorders such as sickle cell disease can have problems with their spleen. This can sometimes lead to a splenectomy, a surgery to remove the spleen.

Spleen and infection risk

If your child’s spleen was removed as part of treatment or does not work properly, they 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 your child develops signs of an infection. An infection can be life-threatening if not treated immediately.

Conditions that may occur if the spleen does not function

If your child’s spleen does not function or work properly, they 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.

Splenectomy

In some cases, removing your child’s spleen because of illness or spleen problems may be the best option.

Your child’s health care team will talk with you about the risks and benefits of removing the spleen. You will also meet with members of the surgery team. They will discuss the surgery with you and get instructions for you on the day of the surgery.

At least 2 weeks before surgery, your child will get any needed vaccines. Talk with your child’s care team about the recommended vaccines.

What to expect

Removing the spleen takes 2 to 4 hours. It is usually done through 1 or more very small incisions in the belly. This makes recovery faster and less painful than for surgery with 1 big incision.

Your child will likely spend 1 or 2 days in the hospital and then go home to rest and finish recovering.

Most children are back to normal activities about 2 weeks after surgery.

Once fully recovered, your child will not have any restrictions on daily activities if his blood counts are good. Your child will continue to see a hematologist 1 to 2 times per year to check blood counts.

Reasons for splenectomy

Below are some reasons your child might need a splenectomy:

• Sickle cell disease—Banana-shaped red blood cells can get trapped in the spleen and damage it. The damaged spleen needs to be removed if this happens.
• Other blood diseases—Removing the spleen can improve blood counts.
• Enlarged spleen—If the spleen gets too large, it can break open and cause life-threatening bleeding.
• High doses of radiation to the abdomen 
• Active chronic graft-versus-host disease as a result of a hematopoietic cell transplant (also known as bone marrow or stem cell transplant)

Signs and symptoms of an infection

If your child has a splenectomy or other spleen problems, knowing the signs of a possible infection is vital. They include:

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

Contact your health care provider if you have these symptoms even if you do not have a fever.

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

Whenever your child has a fever, they must be treated with antibiotics as if they had a serious infection.

A blood culture can help find the source of the infection. Results can take a few hours to a few days.

Steps to prevent spleen problems

• Know your child’s risk of spleen problems. Ask your child’s care team about it.
• If your child is a cancer survivor, share a copy of their Survivorship Care Plan with health care providers. It includes details about their cancer treatment and health problems that may occur because of their 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 your child receives a tick bite, remove the tick and contact your care team about what to do.

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

Malaria

If you and your child 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 care team for a prescription for an anti-malaria medication.

Medical alert emblem

Wear a medical alert bracelet or necklace to alert health care providers that your child does not have healthy spleen function in case they 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.