postsplenectomy

Postsplenectomy refers to the condition or period after splenectomy, the surgical removal of the spleen. The spleen plays a role in filtering bacteria from the bloodstream and in certain immune functions, so its absence increases susceptibility to infections and can lead to other hematologic changes. People who have undergone splenectomy are considered functionally asplenic.

Indications for splenectomy include traumatic splenic rupture or damage, and various nontraumatic conditions such as certain hematologic disorders (for example, autoimmune or hypersplenism-related conditions, hereditary spherocytosis, some anemias), splenic cysts or tumors, and splenic sequestration. The postsplenectomy period thus follows a wide range of prior conditions and surgeries.

The most important risk after splenectomy is overwhelming post-splenectomy infection (OPSI), a rapid, potentially life-threatening sepsis often caused by encapsulated bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. The risk is lifelong, with the highest vulnerability in the early years after surgery, but it remains elevated throughout life. Other notable changes include post-splenectomy thrombocytosis (elevated platelet counts) and a modest increase in risk for venous thromboembolism. Peripheral blood smears may show Howell-Jolly bodies, reflecting loss of splenic filtering.

Prevention and management focus on vaccination and infection prophylaxis. Vaccination protocols typically include vaccines against pneumococcus, meningococcus, and Hib, with schedules tailored to age and local guidance. Antibiotic prophylaxis is recommended for certain groups, especially young children, and fever warrants urgent medical evaluation and often immediate antibiotic treatment. Patients should wear medical alert identification and seek prompt care for febrile illnesses. Regular follow-up with healthcare providers is advised to maintain immunizations and monitor for complications.