The spleen & splenectomy

The spleen filters abnormal red cells, and in thalassaemia it often works overtime and enlarges (splenomegaly). If it grows very large or destroys too many cells — pushing transfusion needs up (above roughly 200 ml/kg/year) — removing it (splenectomy) is one option to reduce iron loading.

With today’s good transfusion and chelation, splenectomy is used much more cautiously and is no longer routine — because life without a spleen brings real risks: serious infection (“OPSI” — overwhelming post-splenectomy infection), blood clots (thrombosis) and raised lung-artery pressure. It’s generally avoided in children under 5.

If a splenectomy is planned, you’ll get vaccines (pneumococcal, meningococcal, Hib) at least 2 weeks beforehand plus annual flu, and often long-term penicillin. Afterwards, platelets rise (thrombocytosis), so blood-clot prevention is used around the operation.

If you’ve had your spleen removed: keep vaccinations up to date, keep any stand-by antibiotics your team prescribed, and treat any fever as urgent.