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Healthy living after treatment of childhood, adolescent, and young adult cancer

Precautions for People Without a Functioning Spleen
The spleen is an organ about the size of a person’s fist that is located in the upper left sideof the abdomen under the rib cage. The spleen helps the body fight infection by filtering theblood. Individuals who lack a functioning spleen are at increased risk for developing serious
infections by specific bacteria (Streptococcus pneumoniae, Haemophilus influenzae, andNeisseria meningitidis) and some parasites transmitted by insects (malaria and Babesia).
Who is at risk for a non-functioning spleen and infections?

••Individuals who had their spleen surgically removed (splenectomy)
Individuals who received a high dose of radiation (at least 40 Gy/4000 cGy) to theabdomen
Individuals with active chronic graft-versus-host disease following a bone marrow orstem cell transplant•

What are the signs of infection and when should I seek treatment?
•

Fever is an important sign of infection. A fever is a temperature at or above 101°F (38.3°C).
–If you have a fever and a non-functional spleen (or have undergone splenectomy),
you should seek urgent medical attention. Fever may be a sign of a serious bacterial
infection and requires blood work and the administration of antibiotics to determine if abacterial infection is present.

•

Other symptoms of infection include unusual tiredness, muscle aches, chills, headache, vomiting, diarrhea, and abdominal
pain. These symptoms can be warning signs of infection even without a fever. Take your temperature regularly any time you
develop symptoms of infection or appear ill.

•If you are having symptoms that you are not sure are related to an infection, contact your healthcare provider for furtherrecommendations.

Is there anything I can do to decrease the risk of infection?
•Vaccinations against haemophilus influenza (HiB), pneumococcus (PCV and PPSV), meningococcus (Men-ACWY, MenB), andinfluenza can decrease the risk of a serious infection.

•In some cases your health care provider may recommend antibiotics to prevent an infection. These antibiotics are called“prophylactic” antibiotics and are taken daily. Antibiotics can decrease the risk of infection in younger children or individuals
who are at higher risk of infection.

What vaccines should an individual receive if they have a non-functioning spleen?
•In addition to the recommended vaccinations for all children and adolescents, individuals with a non-functioning spleenshould receive the following immunizations:-Due to the increased risk of pneumococcal infections, individuals over 2 years of age should receive the PPSV23 vaccine
at least 8 weeks after their last dose of routine pneumococcal vaccination and then revaccinate with PPSV23 vaccine 5years after the first dose.

-Vaccination to meningococcus is recommended for individuals without a functional spleen as early as 2 months of age.
The number and timing of doses is dependent on the type of vaccine received and age at initiation. Vaccination formeningococcal serogroup B is also recommended above 10 years of age.

•Vaccines can be given by your primary care provider.

•Some primary care providers may not be familiar with your specific catch up or booster vaccine schedule. Make sure to give
your primary care provider your cancer team’s contact information for questions.

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Healthy living after treatment of childhood, adolescent, and young adult cancer

Other precautions
Individuals with a non-functioning spleen are at increased risk for other infections:•Malaria: If you travel to countries where malaria is common, take special precautions to avoid getting malaria. Ask yourhealthcare provider for anti-malarial medications before travel to infested areas. During travel, use insect repellants andother protective measures, such as netting and protective clothing.

•Animal/Human Bites: Animal and human bites can result in serious bacterial infections in individuals with anonfunctioning spleen. If you receive a bite that breaks the skin, seek immediate medical attention for treatment withantibiotics.

•Ticks: People without a nonfunctioning spleen are at increased risk for an infection caused by Babesia, a parasitetransmitted by deer ticks. Deer ticks are most commonly found in the northeastern United States. You should wear
protective clothing and use insect repellants when going outdoors in tick-infested areas. If you receive a tick bite while inan area infested with Babesia, you should remove the tick and talk to your healthcare provider about what to do.

How will my healthcare providers know about my non-functioning spleen?

•••

Be sure to tell your doctors, dentists, and other healthcare providers that you do not have a functioning spleen.
You should wear a medical alert emblem (bracelet or necklace) in case of a medical emergency.
Consider carrying a wallet card, with guidelines for healthcare professionals regarding the management of feverin people without a functioning spleen.

Written by S. Ashley Speckhart, MD, MPH, Maine Children’s Cancer Program, Teresa Sweeney, RN, MSN, CPNP, St. Jude Children’s Research
Hospital, Memphis, TN; and Wendy Landier, PhD, CPNP, Children’s Hospital of Alabama, Birmingham, AL.
Reviewed by Kayla L. Foster, MD, MPH and Melissa Acquazzino, MD, MS.

Additional health information for childhood cancer survivors is available atwww.survivorshipguidelines.org
Note: Throughout this Health Links series, the term “childhood cancer” is used to designate pediatric cancers that may occur during childhood, adolescence, or young adulthood.
Health Links are designed to provide health information for survivors of pediatric cancer, regardless of whether the cancer occurred during childhood, adolescence, or young
adulthood.
Disclaimer and Notice of Proprietary Rights
Introduction to Late Effects Guidelines and Health Links: The Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent, and Young Adult Cancers and accompanying Health
Links were developed by the Children’s Oncology Group as a collaborative effort of the Late Effects Committee and Nursing Discipline and are maintained and updated by the Children’sOncology Group’s Long-Term Follow-Up Guidelines Core Committee and its associated Task Forces.
To cancer patients (if children, their parents or legal guardians): Please seek the advice of a physician or other qualified health provider with any questions you may have regarding a
medical condition and do not rely on the Informational Content. The Children’s Oncology Group is a research organization and does not provide individualized medical care or treatment.
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Healthy living after treatment of childhood, adolescent, and young adult cancer

Wallet Card for Patients Without a Functioning Spleen

Physician Phone: _____________________________
Physician Name: _____________________________
Patient Name: _______________________________

Asplenic Patient

MEDICAL ALERTFold here

MEDICAL ALERT: Asplenic PatientThis patient is asplenic and at risk for potentially fatal, overwhelming infections. Immediate medical attention is required for fever of ≥101°F (38.3°C)
or other signs of serious illness. Suggested management includes:
1. Physical exam, CBC and blood culture.
2. Administration of a long-acting, broad-spectrum parenteral antibiotic(e.g., ceftriaxone) accompanied by close clinical monitoring while awaiting blood culture results.
3. Hospitalization and broadening of antimicrobial coverage (e.g., additionof vancomycin) may be necessary under certain circumstances, such as
the presence of marked leukocytosis, neutropenia, or significant change
from baseline CBC; toxic clinical appearance; fever ≥ 104°F; meningitis,pneumonia, or other serious focus of infection; signs of septic shock; orprevious history of serious infection.

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