What are the short and long-term consequences after a splenectomy?
Even during an inpatient hospital stay, quite a few of those affected develop pneumonia or other complaints in the respiratory system. On the one hand, this is due to the fact that the spleen is significantly involved in the storage and multiplication of various immune system defense cells. If the spleen is now removed, this considerably restricts the functioning of the immune system, at least temporarily, and potential pathogens have an easy time of it.
Although the increased susceptibility to infection is relativized after a few weeks, it remains elevated for life. It can sometimes represent a considerable impairment of the quality of life: Every fever after a splenectomy can theoretically be a harbinger of life-threatening sepsis (“blood poisoning”, complex inflammatory reaction of the entire body) and therefore requires immediate medical attention and the initiation of antibiotic therapy. To reduce the risk of such serious consequences of splenectomy, various vaccinations are recommended.
In addition, antibiotic prophylaxis can be considered in the first two years after the removal of the spleen, for example in the form of taking penicillin twice a day. In addition to its involvement in the immune system, the breakdown of older blood platelets (thrombocytes) is one of the main tasks of the spleen. Since the thrombocytes are an essential component of hemostasis, removal of the spleen entails an increased risk of blood clots forming (e.g. portal vein thrombosis, leg vein thrombosis, pulmonary embolism). An individual analysis of the risk-benefit ratio must be carried out before deciding whether a drug-based thrombosis prophylaxis should be initiated: Although the drugs used reduce the risk of thrombembolic events, they also increase the risk of bleeding. If a decision is finally made in favor of such prophylaxis, heparin is used in most cases for the first few weeks and then acetylsalicylic acid (ASA) is used permanently.
Accompanying symptoms after a splenectomy
The splenectomy itself does not cause any symptoms, apart from the pain in the wound area after the operation.However, the limited functionality of the immune system as a result of the splenectomy increases the risk of serious infectious diseases. These sometimes life-threatening courses of disease are known as OPSI (overwhelming post-splenectomy infection). Consequently, any fever or even any fever-free systemic disease of the body can potentially be the starting point for such a life-threatening infection.
In addition to fever, abdominal pain, a rapid heartbeat and all flu symptoms in general (cough, rhinitis, headache, aching limbs) are also early symptoms of OPSI. If one or more of these symptoms occur after a splenectomy, a doctor should be consulted immediately, who can initiate appropriate antibiotic therapy if necessary. Thromboembolic events (thrombosis of the portal vein, leg vein thrombosis, pulmonary embolism), which also occur frequently after a splenectomy, often proceed completely without symptoms over a long period of time and then become suddenly noticeable. While bloody vomiting after removal of the spleen is a sign of a portal vein thrombosis, leg vein thrombosis usually manifests itself in the form of pain, redness, overheating and swelling of the affected leg. Pulmonary embolism, which is usually based on leg vein thrombosis, causes coughing, chest pain, increased heart rate and shortness of breath.
