Preoperative Preparation for Splenectomy

Vaccination Before Surgery

The American Journal of Hematology recommends that patients should be vaccinated against encapsulated bacteria at least 2 weeks before elective splenectomy, including pneumococcal, Haemophilus influenzae type B, and meningococcal vaccines 1
Vaccination should be done at least 2 weeks before surgery to ensure a full antibody response, which typically takes 9 days to develop 1
If vaccination is not possible before surgery, it should be done 14 days after surgery, as delaying it further does not provide additional benefits 1
The Centers for Disease Control and Prevention (CDC) recommends a prime-boost strategy for pneumococcal vaccination, with PCV13 given first, followed by PPSV23 6-12 weeks later 1
Booster doses of pneumococcal vaccine should be given every 6 years 1
The American Academy of Pediatrics recommends that children with sickle cell disease should receive vaccination as part of their routine care, regardless of splenectomy status 2

The American Journal of Hematology recommends a comprehensive medical evaluation by a hematologist or a physician experienced in hematology before splenectomy 2
The evaluation should include an assessment of comorbid conditions, such as cardiovascular, respiratory, renal, and neurological diseases 2
Laboratory tests should include a complete blood count, reticulocyte count, renal function tests, liver function tests, and bilirubin level 2
Blood typing and screening for red blood cell antibodies should be done to prepare for potential blood transfusions 2

The American Journal of Hematology recommends that blood transfusion should be considered before surgery for patients with high-risk procedures or those with a history of bleeding complications 2
The goal of blood transfusion is to increase the hemoglobin level to approximately 100 g/L to reduce the risk of bleeding and viscosity, without exceeding 40 g/L in a single transfusion 3
Simple transfusion or partial exchange transfusion may be used, depending on the patient's initial hemoglobin level, health status, and bleeding risk 3

The American Journal of Hematology recommends that elective splenectomy should be contraindicated in patients with active infection, acute hemolytic crisis, or disseminated intravascular coagulation 2
Patients with poor overall health status or those who are not suitable for surgery should also be contraindicated for elective splenectomy 4

The American Journal of Hematology recommends that patients should receive counseling on the risks and benefits of splenectomy, including the risk of infection and thrombosis 2
Patients should be educated on the importance of lifelong management to prevent infection, including vaccination and antibiotic prophylaxis 5
The American College of Surgeons recommends that patients should be evaluated for any comorbid conditions that may increase the risk of surgery, such as cardiovascular or respiratory disease 4

The Journal of Clinical Oncology reports that the perioperative mortality rate for splenectomy is 5-10% in patients with primary myelofibrosis 4
The American Journal of Hematology reports that postoperative complications occur in approximately 50% of patients, including bleeding, thrombosis, and infection 4
The risk of long-term complications, such as infection and thrombosis, is increased after splenectomy, with a 3-fold increase in infection risk and a 4.5-fold increase in thrombosis risk 5