Splenectomy

• Usual acute post-operative care, including supportive care and monitoring for post-operative complications
• Specific management required for post-splenectomy patients (see below)
• In Victoria, Australia, patients can be placed on a Splenectomy Registry to help ensure appropriate followup

• Immunisation (boosted every 5 years)
  • Pneumococcal
  • HiB
  • Meningococcal C
  • Influenza

• Prophylactic antibiotics (advice largely based on data from children with sickle cell anaemia, little evidence in adults)
  • e.g. amoxicillin
• children less than 5 years of age with sickle cell anaemia (functionally asplenic)
• at least 3 years following splenectomy (some experts advise no antibiotics in an otherwise well adult)
• asplenic patients with severe underlying immunosuppression
• at least 6 months after an episode of severe sepsis in asplenic patients

• Fever management
  • must have a prescription for empiric antibiotics ASAP (e.g. amoxicillin-clavulanate, cefuroxime, moxifloxacin, ceftriaxone)
  • must seek medical attention ASAP

• Advice
  • Asplenic patients should carry a medical alert and an up-to-date vaccination card
  • Asplenic patients require specific advice on travel as they are at increased risk of severe malaria (mosquitoes) and babeosis (tick bites) in endemic areas
  • Asplenic patients require specific advice about animal handling as OPSS (due to Capnocytophaga canimorsus) may result from dog, cat or other animal bites
• Other
  • post-splenectomy thrombocytopenia
  • usually transient but can be marked
  • If >1,000 x 10e9/uL Aspirin 100mg daily po