General measures

The following general measures may prevent serious infection in asplenic patients:

• carrying a "No Spleen" card which details vaccinations, antibiotic therapy and what action should be taken in case of a flu-like illness
  
  
• advice to seek urgent medical attention at early signs of infection in the future, irrespective of prophylaxis
  
  
• aspirin prophylaxis against thrombosis is dependent upon the platelet level and should be controlled by a specialist haematologist

Notes:

• the spleen normally pools a third of the circulating platelets
  • splenectomy is recognized as a cause of portal, mesenteric, and splenic vein thrombosis
    • postsplenectomy portal system thrombosis (PST) occurs in approximately 5% of patients. Possible risk factors are thrombocytosis, splenomegaly, and congenital thrombophilia disorders (1)
  • in the immediate post-operative period in uncomplicated splenectomized patients, the platelet count increases rapidly to a maximum of generally less than 1000 x 10^9/l with a peak at 7-12 days - the thrombocytosis is generally transitory and falls to a level a third higher than in normal subjects over the next 1-2 months
  • study evidence revealed that platelet count of more than 650 x 10^9/l and greater spleen weight (>650 g) was associated with the development of PST
    • the study authors suggest that a platelet count of more than 650 x 10^9/l is directly associated with the development of PST. They suggest that "..It is therefore advisable to administer antiplatelet agents (dipyridamole, aspirin) when severe thrombocytosis occurs postoperatively despite the surgeons' reluctance in their early use.."
    • haematological advice should be consulted concerning the use of antiplatelet agents postsplenectomy

Reference:

• (1)Stamou KM et al. Prospective study of the incidence and risk factors of postsplenectomy thrombosis of the portal, mesenteric, and splenic veins.Arch Surg. 2006 Jul;141(7):663-9