Asplenic/splenectomy prophylaxis

All patients should be offered:

• Appropriate immunisation.
• Lifelong antibiotic prophylaxis. The increased risk of infection in patients with an absent or non-functioning spleen is life-long, but is highest early after splenectomy, with the biggest risk being from pneumococcal infection.
• A "No spleen" card and leaflet “A Guide for People without a Working Spleen”, supplies are available from Health Protection Team (Immunisation) phone: 0131 244 2241 or email: immunisationprogrammes@gov.scot
• Some patients may require rescue therapy, see below.

See comprehensive guidance in the Splenectomy and Dysfunctional Spleen Prophylaxis for Adults and Children guideline.

Coeliac patients should be immunised as per the Lothian consensus guidance LICOG Immunisation and coeliac disease (2017), antibiotic prophylaxis is not required.

Length of prophylaxis

All patients should be offered lifelong antibiotic prophylaxis. The increased risk of infection in patients with an absent or non-functioning spleen is life-long, but is highest early after splenectomy, with the biggest risk being from pneumococcal infection.

All adults should receive antibiotic prophylaxis for at least 2 years following a splenectomy.

Patients deemed to be at higher risk:

• • Aged <16 years or >50 years old
  • Inadequate serological response to pneumococcal vaccination
  • A history of previous invasive pneumococcal disease
  • Splenectomy for underlying haematological malignancy, particularly those who have received splenic irradiation or who have ongoing GvHD are also at continuing high risk.
  • Patients with active ongoing graft-versus-host disease

Patients classified as at "lower risk of invasive pneumococcal infection" may choose to discontinue prophylaxis after counselling, however, these patients have a higher risk of invasive infection than immunocompetent persons, and must have rescue antibiotic available and seek immediate medical attention if unwell