How adults can live safely with asplenia and hyposplenia
This booklet has important information about:
• Living with asplenia and hyposplenia • How to watch for fever and get treatment • How to prevent infection • Vaccinations you will need
Show this booklet and your wallet card to the doctor taking care of you:
• For your vaccinations • If you need to go to the Emergency Department What’s inside
Information for Patients: What is a spleen and what does it do?...... 3 What are asplenia and hyposplenia?...... 4 5 things I should know about living with asplenia or hyposplenia...... 5 How do I know if I have a fever?...... 6 How can I prevent infection?...... 6 Why should I be vaccinated?...... 7 When should I get my vaccines if I am having my spleen removed?...... 8
Information for Healthcare Providers: Immunizations of people with asplenia or hyposplenia...... 8 Management of fever...... 9
2 What is a spleen and what does it do?
The spleen is an organ in the upper left side of the abdomen. A healthy spleen is about the size of your fist.
The spleen makes white blood cells that help fight infections in the body. The spleen also filters blood, removing bacteria and old red blood cells.
Spleen
©UHN Patient Education
3 What are asplenia and hyposplenia?
Asplenia means you have no spleen or you have a spleen that does not work.
Hyposplenia means you have a spleen that works less than normal.
Why do I have asplenia? • You may have been born without a spleen. • You may have been born without a spleen that works. • Your spleen may have been removed by a surgery called a splenectomy. • Your spleen may have stopped working over time.
Why do I have hyposplenia? • You may have been born with a spleen that works less than normal. • Your spleen may have become smaller over time.
4 5 things I should know about living with asplenia or hyposplenia • A fever (a temperature of 38.0° C or higher) is dangerous for you. It could be the start of a life- threatening infection. • You are at risk for infections that can get worse very quickly. • If you get a fever and can get to a hospital within 2 hours: • go immediately to the nearest Emergency Department for medical care, blood tests, and antibiotics. • If you get a fever and you CANNOT get to a hospital within 2 hours: • take one dose of a prescribed antibiotic by mouth, such as: amoxicillin, levofloxacin, or moxifloxacin • then go to the nearest Emergency Department as soon as possible. • You should get vaccines to try to prevent infections from certain bacteria and viruses.
5 How do I know if I have a fever?
The best way to know if you have a fever is to take your temperature. We recommend that you buy a thermometer so that you can measure your temperature. If you have a temperature of 38.0 °C (100.4°F) or higher, that means you have a fever.
You may also experience: • Chills • Shivering • Sweats
How can I prevent infection?
1. Wash your hands well with soap and water. 2. Avoid people who are sick. 3. Become vaccinated.
6 Why should I be vaccinated?
The spleen is an organ that plays an important role in your immune system. It helps to fight disease and infections. People with asplenia or hyposplenia are at risk of certain infections.
It is especially important for people with asplenia or hyposplenia to be vaccinated against: • Meningococcus • Haemophilus influenzaetype b • Pneumococcus • Influenza virus (the flu)
To learn more about vaccines: • Speak to your doctor or nurse at your next clinic appointment if you have questions about vaccines.
Call Immunize Canada at 613-725-3769 extension 122 or your local Public Health unit.
7 When should I get my vaccines if I am having my spleen removed?
For planned splenectomy, get vaccinated at least 2 weeks before the surgery.
For emergency splenectomy, it is best to get vaccinated 2 weeks after surgery (or earlier if you are unsure you can follow up vaccines at that time).
You will need more than one dose for some of the vaccines. Schedule an appointment with your doctor to arrange this.
Information for healthcare providers: Immunizations of persons with asplenia or hyposplenia
Use the current recommendations of the Canadian Immunization Guide at:
Website: http://bit.ly/CanadianImmunizationGuide
8 Information for healthcare providers: Management of fever
Fever 38.0°C (100.4°F) or higher in person with asplenia/hyposplenia
Able to get to the nearest Emergency Department within 2 hours No
Yes Person with asplenia/hyposplenia should take a single dose of antibiotic by mouth, such as amoxicillin, levofloxacin, or moxifloxacin
Person with asplenia/hyposplenia should go to the nearest Emergency Department for assessment and testing, including two blood cultures from two different sites.
Person appears ill or results of laboratory test abnormal (e.g. evidence of sepsis) Yes No Give antibiotic therapy such as Give antibiotic therapy such ceftriaxone with vancomycin as ceftriaxone
Admit to hospital unless patient Admit to hospital can follow-up with hematologist or family physician within Please contact on-call Infectious 2-3 days Disease physician and/or on-call Hematologist at your institution If discharged, give an oral for any questions/additional antimicrobial and confirm an guidance. appointment with hematologist or family physician within 2-3 days 9 Notes
10 Created by:
St. Michael’s Hospital: Dr. Michelle Sholzberg Dr. Linda Taggart Dr. Jillian Baker Natalya O’Neill
University Health Network: Dr. Richard Ward Colleen Johnson Emily Susan Nelson
Reviewed by members of: Emergency Department, St. Michael’s Hospital Department of Family and Community Medicine, St. Michael’s Hospital Emergency Department, University Health Network Department of Family and Community Medicine, University of Toronto UHN Patient Education and engagement Patient and Family Education, St. Michael’s Hospital
11 St. Michael’s cares about your health. For reliable health information, visit our Patient and Family Learning Centre, or find us online at wwwstmichaelshospital.com/learn
This information is not intended as a substitute for professional medical care. Ask your healthcare provider about this information if you have questions.
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73570 Rev. Aug.27 2018 V3