Spleen problems and spleen removal

About the spleen

The spleen is an important part of your immune system but you can survive without it.

This is because the liver can take over many of the spleen's functions.

The spleen has a few important functions:

• it fights any invading germs in the blood (the spleen contains infection -fighting white blood cells)
• it controls the level of white blood cells, red blood cells and platelets (small cells that form blood clots)
• it screens the blood and removes any old or damaged red blood cells

If the spleen doesn't work properly, it may start to remove healthy blood cells. This can lead to:

• anaemia, from a reduced number of red blood cells
• an increased risk of infection, from a reduced number of white blood cells
• bleeding or bruising, from a reduced number of platelets

Spleen problems

Spleen pain

Spleen pain is usually felt as a pain behind your left ribs. It may be tender when you touch the area. This can be a sign of a damaged, ruptured or enlarged spleen.

A damaged or ruptured spleen

The spleen can become damaged or may rupture (burst) after a forceful blow to the abdomen, car accident, sporting accident or fracture to the ribs. 

Rupture can happen straight away or it may happen weeks after the injury.

Signs of a ruptured spleen are:

• pain behind your left ribs and tenderness when you touch this area
• dizziness and a rapid heart rate (a sign of low blood pressure caused by blood loss)

Sometimes, if you lie down and raise your legs, the pain can be felt at the tip of your left shoulder.

A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding.

Go to your nearest emergency department if you think you've ruptured or damaged your spleen.

Enlarged spleen

The spleen can become swollen after an infection or injury.

It can also become enlarged as a result of a disease, such as:

• cirrhosis
• leukaemia
• rheumatoid arthritis

An enlarged spleen doesn't always cause symptoms. You should look out for:

• feeling full very quickly after eating (an enlarged spleen can press on the stomach)
• feeling discomfort or pain behind your left ribs 
• anaemia and/ or fatigue
• frequent infections
• easy bleeding

Doctors can often tell if you have an enlarged spleen by feeling your abdomen.

A blood test, CT scan or MRI scan would confirm the diagnosis.

The spleen is not usually removed if it's just enlarged.

Instead, you'll receive treatment for any underlying condition and your spleen will be monitored.

Antibiotics may be prescribed if there's an infection.

You'll need to avoid contact sports for a while. This is because you’ll be at greater risk of rupturing the spleen while it is enlarged.

Surgery is only necessary if the enlarged spleen is causing serious complications or if the cause can't be found.

Splenectomy (having the spleen removed)

An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged.

Or you may need to have just part of your spleen removed – a partial splenectomy.

The surgeon looking after your care will explain to you the most suitable treatment option.

If there's time, you'll be advised to have a series of immunisations before the operation.

Living without a spleen

If your spleen needs to be removed, other organs, such as the liver, can take over many of the spleen's functions. 

This means you will still be able to cope with most infections.

There is a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.

Risk of infection

Young children have a higher risk of serious infection than adults, but the risk is still small.

The risk is also increased if you have a medical condition such as:

• sickle cell disease (sickle cell anaemia)
• coeliac disease 
• a condition that affects your immune system, such as HIV

This risk can be minimised by following simple precautions to prevent infection.

Vaccinations

Make sure you have had all your routine childhood vaccinations.

You should also be vaccinated against:

• pneumococcal infections such as pneumonia, with regular boosters at least every five years
• flu (get the seasonal flu jab every autumn) 
• Haemophilus influenzae type b (Hib) 
• meningitis C (MenC) 

Antibiotics

It's recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections. Antibiotics are particularly important:

• for children under the age of 16
• for the first two years after your spleen is removed 
• if your immune system doesn't work properly

Be alert for signs of infection

Watch out for signs of infection, such as:

• high temperature (fever)
• sore throat 
• cough
• severe headache 
• headache with drowsiness or a rash 
• abdominal pain 
• redness and swelling around the surgical wound

Your GP can prescribe a course of antibiotics for you to use if you get an infection. You should start taking them at the first sign of an infection, so see your GP as soon as possible.

If your infection becomes serious, you will be admitted to hospital.

Telling medical staff about your condition

Healthcare professionals will mark your health records to show that you don't have a working spleen. Always remember to tell any medical professionals that you see, including your dentist.

Travel abroad

If you're travelling abroad:

• you may be advised to take a course of antibiotics with you
• find out if you need an extra meningitis vaccination (types ACWY) 
• check if you need any travel vaccinations 

People without a working spleen have an increased risk of developing a severe form of malaria. If possible, avoid countries where malaria is present.

If you can't, speak to your GP or local pharmacist about anti-malaria medicine before you travel. You should also use mosquito nets and insect repellent.

More useful links

• Spleen problems and spleen removal
• How to use your health services