The spleen is located behind the stomach in the left upper quadrant of the abdomen. It is approximately five inches long by three inches wide, and just under two inches thick. Although it has many functions—including filtering blood, destroying abnormal cells, storing of iron and blood, and defending against infections and parasites—many people live normal lives without a spleen. Reasons for surgical removal, or splenectomy, include trauma, liver disease, infection, blood diseases and cancer. The liver, lymph glands and other parts of the body may be able to almost entirely compensate for the loss of the spleen.
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There may be an increase in all types of blood cells after spleen removal, due to the loss of the organ normally responsible for destroying excess cells. According to The American Pediatric Surgery Association (APSA), this effect is expected and rarely becomes a concern in children. For older patients, a daily regimen of therapy with aspirin or another blood thinner may be necessary to prevent the formation of blood clots due to increased platelet cells. Platelet levels usually return to normal within the first year, as the liver takes over some functions previously handled by the spleen. Blood cells can be rechecked in several months and medication adjusted or discontinued under the care of a physician.
Increased Infection Risk
Without a spleen, serious infections can result following what would normally be minor illnesses. The risk can be lowered by the administration of vaccines for pneumonia, meningitis and influenza prior to surgical removal of the spleen, if possible, or soon after. The risk of developing serious infections is much greater in children than adults, according to APSA. Usually it will present within two years of splenectomy, but infection can occur at any time. It is important to keep vaccines current.
The prophylactic use of antibiotics is advised by many physicians, particularly for children until they reach adulthood. But an increase in drug-resistant pathogens makes this approach controversial. All patients should be educated to avoid unnecessary risks and to take prompt action at the first sign of illness.
After spleen removal, special considerations should be revisited when going camping or planning international travel. The advice of a knowledgeable physician can guide decisions when it comes to additional vaccine recommendations, extra precautions to prevent mosquito and tick bites, and supplies of preventative medications. Some destinations are more dangerous than others, such as areas where malaria is endemic. Other destinations to reconsider include Saudi Arabia, where meningitis infections are on the rise, and Spain, where penicillin-resistant bacteria are gaining prevalence, according to the Department of Public Health and Infectious Diseases.
REFERENCES & RESOURCES
- Dept. of Public Health and Infectious Diseases, Health Service Executive: Guidlines for the Prevention and Treatment of Infection in Patients With an Absent or Dysfunctional Spleen; September, 2002
- The American Pediatric Surgery Association: Spleen Problems
- Children's Hospital of Pittsburgh: Spleen Information, Surgery and Functions
- Centers For Disease Control and Prevention: Travelers' Health