By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

WITHOUT A SPLEEN, PRECAUTIONS NEEDED TO AVOID DEADLY INFECTIONS

Question: I am a 30-year-old man. I was in a car accident when I was 14 and had my spleen removed. I was told there was nothing to worry about because I could live just fine without a spleen. Is this still true? Are there things I should be doing or not doing because I don’t have a spleen?

Answer: We physicians know more about the spleen and what it does now than we did 16 years ago. And while it is quite true that you can live “just fine” without a spleen, there are some vaccinations you should be getting on a regular basis as well as things you need to know about the special care you should take in managing illnesses.

First, let me tell you a bit about the spleen. The spleen is an organ that is in the left, upper portion of the abdomen. It’s about the size of your fist.

One significant function of the spleen is to serve as a reservoir for certain blood components, especially white blood cells that help fight infections, and platelets that are necessary for clotting. Special types of white blood cells are produced in great quantities in the spleen, then released into the bloodstream to battle infections.

The spleen also filters small particles from the blood, especially bits and pieces of worn out red blood cells and bacteria. After recovering worn out red blood cells, the spleen also recycles them. When the spleen captures bacterial invaders, the immune system within this organ attacks and destroys them.

Because it performs these functions, the spleen has a very large blood supply. If it’s injured -- like in the car accident you were involved in -- the result can be life-threatening internal bleeding. That’s probably why your spleen was removed. The operation no doubt saved your life at the time.

The spleen is particularly adept at helping your body fight infections caused by what’s known as “encapsulated bacteria.” These are germs with an outer coating that protects them from the body’s immune system. They include Strep pneumoniae, Hemophilus influenzae B, and Neisseria meningitidis, which cause pneumonia, ENT infections, and meningitis, respectively.

Infection by this type of bacteria can lead to an uncommon, but often fatal, problem called overwhelming postsplenectomy sepsis (OPSS) in an adult without a spleen. OPSS occurs in up to 2 percent of people who have had their spleens removed -- sometimes as long as 65 years after the surgery. Unfortunately, more than 50 percent of those who develop OPSS die. The good news is that most cases of OPSS can be prevented with proper immunizations.

It is advised that anyone who has had his or her spleen removed should have the polyvalent pneumonoccal vaccine (Pneumovax) every 6 years, the meningitis vaccine (Menomune) every 3 to 5 years, and the hemophilus vaccine once. Additionally, a flu shot is needed annually.

Finally, if you become ill with fever, chills, abdominal pain, coughing, vomiting or a skin infection, see your doctor sooner rather than later. These could be the early signs of OPSS. Also be sure your primary care physician is aware of your surgical history and keeps you up to date on the recommended vaccinations, which may change over time as we learn more.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.