Risk of Infection After Splenectomy
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Addenbrooke's Hospital has recently published an updated directive on the
in-creased risk of infection to people without a spleen, writes Sandy
Maclachlan Our panel of doctors from the four Gaucher's Centres have added
their advice. Here is a reminder of the procedures to reduce the risk for those
who have had their spleen removed. Seek the advice of your doctor for further
- Any symptoms suggestive of infection should be brought to the attention of
your GP immediately.
- Everyone should have a Pneumo-vax vaccine, ideally before splenectomy, and
repeated 5-10 years later.
- A single vaccine of HIB is recommended.
- A Meningovax vaccine is recommended for children and adults.
- An annual influenza vaccination is recommended in early autumn.
- Oral prophylactic (preventative and continuous) antibiotics (Augmentin for
under 5 year olds; thereafter penicillin V) is advised until at least 16 years
of age. Patients over this age should take it for at least two years after
splenectomy although most authorities recommend a lifelong prophylactic dose.
Patients allergic to penicillin can be offered Erythromycin. As an alternative,
you may be given a course of antibiotics to keep at home in case you become ill
and there is a delay in seeing your doctor.
- A clear record of all vaccinations and dates given should be kept.
- Patients should check with their GP when travelling abroad regarding any
extra vaccinations which may be necessary, especially regarding the risk of
contracting malaria. Precautions should be taken to avoid mosquito bites but
the best way to avoid malaria is not to go to endemic areas. Anti-malarial
drugs do not provide complete protection and it might be wise to carry a course
of antibiotics with you, whether or not you are taking daily antibiotics.
- A number of parasites are borne by ticks (and other insects) which can
cause severe inflammation. More and more of these organisms are being
recognised, such as the carrier of Lyme disease which abounds in North American
and European forests including the UK and the carrier of babesiosis. Holidays
where limbs are in contact with forest undergrowth or tall grasses put people
at particular risk from these infections. Wearing clothing to cover exposed
skin, especially long trousers to protect the legs, helps prevent tick bites.
People receiving these bites should report to a doctor for antibiotic
- Human and animal bites should be treated immediately and a course of five
days antibiotics given.
- All doctors treating patients with Gaucher's disease, including surgeons
and dentists, should be reminded about the risk of infection in relation to
splenectomy. This especially relates to post-operative infection. Prompt
treatment of suspected infection would require the use of injected antibiotics
and the advice of an informed doctor.
An SOS talisman may be worn which records all vaccinations and
symptoms in case of an accident. This is a locket with a piece of paper inside
which is attached to a necklace or bracelet. They are available from some
chemists and jewellery shops or direct from Talman Ltd, 21 Grays Corner, Ley
Street, Ilford, Essex IG2 7RQ; tel: 0181 554 5579. Send a stamped addressed
envelope for a brochure.
A MedicAlert bracelet or necklace has brief details inscribed on it
which you supply eg splenectomy, allergic to penicillin, together with a phone
number which a doctor may ring at any time to obtain further information stored
on a computer. Prices vary according to whether the jewellery is in stainless
steel, silver or gold. To obtain more information, contact the MedicAlert
Foundation, 1 Bridge Wharf, 156 Caledonian Road, London N1 9UU; free phone 0800
The Dept of Health supplies a card (the size of a credit card) which
says 'I have no functioning spleen'. It also has space to write your name,
address, telephone number, GP's and hospital's details plus immunisation
details. You can possibly get one from your doctor or by writing to the
Department of Health, PO Box 410, Wetherby, LS23 7LN or faxing 0990 210 266.
Source: Gaucher's News July 1999
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© Copyright Gaucher's Association 1999