Splenectomy, while often necessary in otherwise healthy patients after major
trauma, finds its primary indication for patients with underlying malignant or nonmalignant
hematologic diseases. Indications of
splenectomy for
hematologic diseases have been reducing in the last few years, due to improved diagnostic and therapeutic tools. In high-income countries, there is a clear decrease over calendar time in the incidence of all indication
splenectomy except nonmalignant
hematologic diseases. However,
splenectomy, even if with different modalities including laparoscopic
splenectomy and partial
splenectomy, continue to be a current surgical practice both in nonmalignant
hematologic diseases, such as
Immune Thrombocytopenic Purpura (
ITP),
Autoimmune Hemolytic Anemia (AIHA),
Congenital Hemolytic Anemia such as Spherocytosis,
Sickle Cell Anemia and
Thalassemia and Malignant
Hematological Disease, such as
lymphoma. Today millions of people in the world are splenectomized.
Splenectomy, independently of its cause, induces an early and late increase in the incidence of
venous thromboembolism and
infections.
Infections remain the most dangerous complication of
splenectomy. After
splenectomy, the levels of antibody are preserved but there is a loss of memory B cells against pneumococcus and
tetanus, and the loss of marginal zone monocytes deputed to immunological defense from capsulated bacteria. Commonly, the
infections strictly correlated to the absence of the spleen or a decreased or absent splenic function are due to encapsulated bacteria that are the most virulent pathogens in this set of patients. Vaccination with
polysaccharide and
conjugate vaccines again Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis should be performed before the
splenectomy. This practice reduces but does not eliminate the occurrence of overwhelming
infections due to capsulated bacteria. At present, most of
infections found in splenectomized patients are due to Gram-negative (G-) bacteria. The underlying disease is the most important factor in determining the frequency and severity of
infections. So,
splenectomy for malignant diseases has the major risk of
infections.