Preoperative and postoperative measures to reduce and/or prevent complications after splenectomy
| Before or after splenectomy . | Measures . |
|---|---|
| Before splenectomy | |
| Patient education regarding risk of overwhelming sepsis | Early administration of oral antibiotic therapy that covers S pneumoniae and H influenzae in case of fever (amoxicillin-clavulanate, cefuroxime axetil, or levofloxacin) AND immediate travel to a hospital for assessment and intravenous antibiotics |
| Vaccination | Vaccination against S pneumoniae, meningococcus, and H influenzae type b, ideally at least 14 days before scheduled splenectomy |
| Elevation of platelet count | Elevation of platelets to > 50 × 109/L by steroids or IVIg or another treatment |
| After splenectomy | |
| Antibiotic prophylaxis | Postoperative antibiotics prophylaxis until the risk of infection is abated |
| Thromboprophylaxis | Early mobilization, good hydration, and early initiation of prophylactic anticoagulants once hemostasis is ensured if any risk of thrombosis |
| Discontinuation of other treatments | Gradual tapering of steroids, discontinuation of TPO-RAs (provided that counts are good) |
| Revaccination | Vaccination against S pneumoniae every 5 years and annual flu vaccine |
| Regular follow-up | Responding patients require platelet count every 3 months for 1 year and no less than annually thereafter patients need to be reminded of precautions. Pregnancy requires reevaluation |
| Before or after splenectomy . | Measures . |
|---|---|
| Before splenectomy | |
| Patient education regarding risk of overwhelming sepsis | Early administration of oral antibiotic therapy that covers S pneumoniae and H influenzae in case of fever (amoxicillin-clavulanate, cefuroxime axetil, or levofloxacin) AND immediate travel to a hospital for assessment and intravenous antibiotics |
| Vaccination | Vaccination against S pneumoniae, meningococcus, and H influenzae type b, ideally at least 14 days before scheduled splenectomy |
| Elevation of platelet count | Elevation of platelets to > 50 × 109/L by steroids or IVIg or another treatment |
| After splenectomy | |
| Antibiotic prophylaxis | Postoperative antibiotics prophylaxis until the risk of infection is abated |
| Thromboprophylaxis | Early mobilization, good hydration, and early initiation of prophylactic anticoagulants once hemostasis is ensured if any risk of thrombosis |
| Discontinuation of other treatments | Gradual tapering of steroids, discontinuation of TPO-RAs (provided that counts are good) |
| Revaccination | Vaccination against S pneumoniae every 5 years and annual flu vaccine |
| Regular follow-up | Responding patients require platelet count every 3 months for 1 year and no less than annually thereafter patients need to be reminded of precautions. Pregnancy requires reevaluation |
IVIg indicates intravenous immunoglobulin.