Indications for splenectomy can be classified into emergency and elective indications:
Indications for emergency splenectomy include trauma and rupture (e.g. in EBV infection
An elective splenectomy may need to be done in cases of hypersplenism, where the spleen has a preference for platelets resulting in increased uptake, which leads to sequestration of cells in the spleenIndications for elective splenectomy include haemolytic anaemia (hereditary or immune) and idiopathic thrombocytopenic purpura
Changes in blood film
Patients post-splenectomy will have Howell-Jolly bodies and Pappenheimer bodies on blood film
Susceptibility to infections
Following splenectomy or in patients with hyposplenism (dysfunctional spleen, e.g. in coeliac disease) there is a reduced immune response against encapsulated organisms (haemophilus, pneumococcus, and meningococcus)
Note: the risk of infection is particularly high in the 2 years following splenectomy, the highest risk being from pneumococcal infection
Prophylaxis
Patients therefore require the following vaccinations:
Pneumococcal vaccination (with regular boosters every 5 years)
Seasonal influenza vaccination (yearly, typically every autumn)
Haemophilus influenza type B vaccination (one-off)
Meningitis C vaccination (one-off).
Patients also require daily low-dose prophylactic antibiotics, often for life
The typical regimen is with phenoxymethylpenicillin which is also known as penicillin V (clarithromycin or erythromycin if patients are allergic to penicillin)