Splenectomy

The reasons for a splenectomy are as follows:

1 It is already ruptured and needs to come out because it is bleeding.

2 For making a diagnosis.

3 In ITP failing to respond to steroids.

4 In autoimmune hemolytic anemia not controlled by medicines.

5 To facilitate access during a cancer operation.

6 For hypersplenism - this means that the size of the spleen is such that it contains a large proportion of the red cells, white cells or platelets - either destroying them or pooling them - so that the patient is embarrassed by lack of them. There might be a relative hypersplenism because the balance of production and destruction is tipped in favor of destruction. Nowadays it is more usual to boost production with EPO (for red cells) or G-CSF (for granulocytes).

7 In rare types of congenital hemplytic anemias or thrombocytopenias.

Patients who have their spleen removed need to protected against overwhelming pneumococcal septicemia. The normal way is by vaccination but it does nor work if you have CLL and therefore antibiotics for life are needed. Usually benzyl penicillin is needed, though other antibiotics are sometimes favored.