Your Spleen - Why Can You Live Without It?

Sometimes, through injury or disease, a person may have to have their spleen removed. When the whole organ is removed it is called a splenectomy, but sometimes only part of the spleen needs to be removed, which is called a partial splenectomy. The spleen plays a very important role in your health and the function of your body, so how is it that you can actually live without it?

The Role of the Spleen

The spleen is an organ that is located in the lower abdomen. The main priority of the spleen is to store red blood cells and purify them, removing the waste products. This purification process helps your immune system recognize any allergens or foreign pathogens, which results in the body fighting off the foreign invaders and infections.[1]

Reasons for Removal

The most common reason for a splenectomy is following a traumatic event. Often it is due to a high-speed impact, such as in a vehicle crash, or a blunt force injury to the abdomen. These types of trauma can result in a ruptured spleen, meaning the organ itself has burst open, leading to internal bleeding, which is a life-threatening condition. When this occurs, the spleen is usually removed to prevent further blood loss.[1]

There are a number of diseases that can necessitate the removal of the spleen. Some diseases can cause the spleen to swell, increasing the fragility of the organ and leading to the risk of rupture. Other diseases have the opposite effect, where the spleen shrivels and ceases to function. In this case, the term given is an auto-splenectomy, meaning the spleen has more or less removed itself.

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Other diseases that affect the spleen and may require a splenectomy include [2]:

• Hereditary spherocytosis
• Thalassemia
• Hereditary elliptocytosis
• Hereditary nonspherocytic hemolytic anemia
• Splenic artery aneurism
• Blood clot in the vessels of the spleen
• Leukemia
• Lymphoma
• Abscess, cyst or infection of the spleen

Splenectomy: What To Expect

Complications of a Splenectomy

Apart from the ever present risk of any surgical procedure, there are further complications that can arise following the removal of your spleen. The number one risk is the development of infections, as without the spleen the body’s ability to fight off infection is very poor. The type of infections can include haemophilus influenza, streptococcus penumoniae, and Neisseria meningitides. These types of bacteria can cause meningitis, pneumonia, both of which can be life-threatening illnesses.[3]

To help prevent these serious bacterial infections, there are some vaccinations that can be given. These are often given around 2 weeks before the splenectomy, where possible. Of course, in the case of traumatic injury, this isn’t possible. In this scenario, the vaccinations can be given 2 weeks following the splenectomy.

For children who have their spleen removed, they are generally prescribed daily antibiotics, until they reach adulthood. This is not necessary for adults, as their immune system is generally stronger, and there is a lower chance of developing the infections. However, if the person has other medical issues that affect their immunity, an adult may also be put on daily antibiotic treatment.[4]

Certain precautions should be taken following a splenectomy if you are planning to travel, especially on trips to other countries. If you are taking regular antibiotics, it is a good idea to take a good supply with you, just in case they are not available where you are going. Also, all possible vaccinations should be done to prevent the development of foreign infections. Some countries have a lower standard of medical treatment and care, and depending on where you are going, there may be a shortage of medicines available. Your doctor will be able to advise you on what you need to take with you.

What Is the Long-Term Prognosis?

Many people go on to live full and healthy lives without their spleen. If you are generally healthy without any complicating medical problems, you are going to be less at risk of developing dangerous infections. In saying that though, you will also need to keep a good eye on your health, and regular medical check-ups will be necessary. For some, vaccinations and antibiotics for prophylaxis may be a requirement, particularly in children.[3,4]

There has been some debate about prophylactic antibiotics, given the development of antibiotic resistant organisms. These so-called ‘superbugs’ such as MRSA have become resistant to common antibiotics, resulting in difficult to treat and sometimes life-threatening infections. However, the benefits of prophylactic antibiotics in those without a spleen outweigh the risk, and for some, it is the only way to ensure they stay healthy.

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Staying Healthy

Your doctor will be able to advise you on the best possible way to protect your body and your immune system following the removal of your spleen. This may include diet, exercise, lifestyle changes, and daily medication. This doesn’t mean your life will be shortened by any degree, it simply means that you will need to be more aware of how your body is functioning and be ready to seek medical attention at the first sign of illness. 

Preservation of the spleen following abdominal trauma and spleen-preserving surgical procedures are still the golden standard. However, about 22,000 splenectomies are still conducted annually in the USA, and infections are the most well-known complications following splenectomy. The latest reports recognize thrombosis and cancer as one of the most threatening outcomes after removal of the spleen (splenectomy), adding pneumonia, meningitis, and septicemia, deep venous thrombosis and pulmonary embolism, certain solid tumors and hematologic malignancies (non-Hodgkin lymphoma, Hodgkin lymphoma, multiple myeloma, acute myeloid leukemia, chronic lymphocytic leukemia, chronic myeloid leukemia, and any leukemia) to the list. [5]