A non-functioning spleen may be due to blood dyscrasia, coeliac disease, inflammatory bowel disease, bone marrow or stem cell transplant, dermatitis herpetiformis or may be congenital.
Patients with absent or non-functioning spleen are at increased risk of overwhelming infection, particularly with Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, influenza and malaria in travellers.
Check immunisation history with patient, administer vaccinations appropriately (see below for link to the Green Book) and inform patient's GP.
| Procedure | Time schedule for vaccinations |
| Elective splenectomy | Where possible, vaccination course should ideally be started at least 2 weeks before surgery or start of immunosuppressive treatment. |
| Emergency splenectomy |
2 weeks post-operatively (functional antibody response may be better with delayed vaccination). |
| Completion of radio- or chemotherapy | Delay vaccination for at least 3 months. |
See Chapter 7 of the Green Book.
All patients with an absent or dysfunctional spleen should receive prophylactic antibiotics for at least 2 years, but ideally for life. Prophylactic antibiotics should be started immediately post-surgery.
Phenoxymethylpenicillin (Penicillin V) oral 250mg twice daily.
If true penicillin / beta-lactam allergy: Erythromycin oral 500mg twice daily.
Further information can be found in the Public Health Scotland document 'A guide for people without a working spleen'.
| Guideline reviewed | March 2024 |
| Page updated | September 2024 |