No Spleen? Get Vaccinated

Approximately 5 percent of patients who have splenectomies develop infections later in life. Although infections are rare, they are life-threatening.

The spleen plays a role in fighting infections in the body. Approximately 50-70% of infected spleen patients die.

A recent study about the pharmacist's role in vaccinating asplenic patients identifies a clear role for community-based vaccination for these patients.

Prior to the interventions during this study, 68% of patients had been vaccinated. After the pharmacist intervention, immunization rate increased to 77%.

The greatest gains were noted in compliance with the pneumococcal vaccination series.

The Centers of Disease for Control and Prevention (CDC) reports that if you do not have a spleen, or your spleen does not work well, talk with your doctor or pharmacist about:

• Influenza vaccine each year to protect against seasonal flu
• Tdap vaccine to protect against whooping cough and tetanus
• Hib vaccine to protect against Haemophilus influenzae type b (Hib) if you were not previously vaccinated with the vaccine
• Pneumococcal vaccines (both types) to protect against pneumonia and other pneumococcal disease
• Meningococcal vaccines (both types) to protect against meningitis and other meningococcal disease
• Zoster vaccine to protect against shingles if you are 60 years and older
• HPV vaccine series to protect against human papillomavirus if you are a man up to age 21 or woman up to age 26
• MMR vaccine to protect against measles, mumps, and rubella if you were born in 1957 or after and have not gotten this vaccine or do not have immunity to these diseases
• Varicella vaccine to protect against chickenpox if you were born in 1980 or after and have not gotten two doses of this vaccine or do not have immunity to this disease

Part of the problem is that asplenic patients are at elevated risk of infection with Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenza type B.

An additional finding of this study was that poor documentation was a serious concern in asplenic patients' electronic medical records. It made it very difficult to determine if the patient had been vaccinated or when.

These researchers noted that pharmacists need to be integral parts of the vaccination workflow to be most effective.

Pharmacists may have difficulty keeping up with vaccination guideline changes. Incorporating guideline changes and appropriate vaccines into the electronic medical record tracking system may help reduce that confusion, according to the researchers.

The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. The spleen’s function is to store red blood cells and help remove “old” cells and other particles from circulation.

According to the University of Michigan, after splenectomy, there is a lifelong increased risk for life-threatening infections. Although the risk is very low (less than 1%), you can take the following steps to protect your health:

• Get vaccinated.
• Keep a record of all vaccinations. If you have more than one health care provider, be sure each one knows.
• Wear a Medical Alert Bracelet, and/or carry a Medical Alert Card on you that states you have had your spleen removed.
• Your primary care provider should periodically check your blood counts to insure that your clotting factors (platelets) are in order.