Medical Oncologist
CION Cancer Clinics
Infection risk after splenectomy: the lifelong issue | CION Cancer Clinics
The spleen catches a small group of bacteria that nothing else in the body catches as well. Once it is removed, the risk of a fast, serious blood infection, called OPSI, is small in any year but never goes away. This page explains which germs are involved, who is most at risk, and the four layers of protection that lower it. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MM
Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- Why is infection a lifelong risk after a splenectomy?
- Which infections are you more open to?
- Words on your discharge summary, in plain language
- The four layers that lower the risk
- When is the risk highest, and who is most at risk?
- What families assume about the risk, and what is actually true
- Common questions about infection after splenectomy
The short answer
Why is infection a lifelong risk after a splenectomy?
Because the spleen is the organ that catches a particular group of bacteria, and once it is gone nothing else does that job as well. The risk is small in any one year, but it never goes away, and when one of these infections takes hold it can become life-threatening within hours. That combination, rare but fast, is why doctors treat it so seriously.
What OPSI means on your papers
OPSI stands for overwhelming post-splenectomy infection. It describes a bloodstream infection that starts like a fever and turns into shock very quickly in a person without a spleen. It is uncommon. But it is the single thing every part of your after-care is designed to stop: the vaccines, the antibiotics, the card and the fever rule.
Why the spleen matters for these germs in particular
Some bacteria wrap themselves in a sugar coat that hides them from the rest of the immune system. The spleen holds the cells that can see through that coat. The liver and marrow take over most of the spleen's other work, but not this part. That is the gap the vaccines fill.
This page explains the risk. It cannot tell you your own level of risk, which depends on your age, why the spleen was removed, and what other treatment you are having.
!
Fever without a spleen is an emergency
If you have no spleen and you develop a fever, shivering, or feel suddenly and unusually unwell, go to the nearest hospital the same day, at any hour, and say you have had a splenectomy. Do not wait until morning, and do not take a paracetamol to see if it settles. If you have a stand-by antibiotic at home, take it as instructed and still go. The hours matter more than the thermometer reading.
Not sure whether this applies to you?
Ask an oncologistThe germs
Which infections are you more open to?
These are the ones the spleen used to catch. Most have a vaccine, which is why the vaccine list looks the way it does.
Pneumococcus
The commonest cause of serious infection after splenectomy. It usually causes pneumonia, but without a spleen it can spread into the blood fast. Vaccinated against, with boosters on a schedule your doctor sets.
Meningococcus
Causes meningitis and blood poisoning. Less common than pneumococcus but very fast-moving. Vaccinated against; there are two different vaccines because there are several strains.
Hib
Haemophilus influenzae type b, a bacterium, not the flu virus. It is rare in vaccinated adults but still on the list. A single dose is usually given after the operation if you have not had it.
Malaria and bite germs
The spleen clears malaria parasites from the blood, so malaria is more severe without one. A bacterium carried in dog and cat mouths can also cause serious illness after a bite. Neither has a vaccine; both need prompt care.
The habit
- Nets and repellent, all year
- Any animal bite seen the same day
On your papers
Words on your discharge summary, in plain language
- Asplenia
- Having no spleen. Post-splenectomy asplenia means it was removed by surgery.
- Hyposplenism
- A spleen that is present but not working well. It carries the same precautions as having none, and can follow radiotherapy or some blood cancers.
- OPSI
- Overwhelming post-splenectomy infection. A bloodstream infection that becomes dangerous within hours. Rare, and the reason for every precaution on this page.
- Encapsulated bacteria
- Germs with a sugar coat that the spleen was needed to catch: pneumococcus, meningococcus and Hib are the main ones.
- Sepsis
- The body's dangerous over-reaction to an infection in the blood. This is what OPSI becomes if it is not treated quickly.
- Stand-by antibiotics
- A course kept at home to start at the first sign of fever while you travel to hospital. Your doctor tells you exactly when to use it.
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The protection
The four layers that lower the risk
Vaccines
Against pneumococcus, meningococcus and Hib, given before the operation where time allows and afterwards where it does not, plus a flu vaccine every year. Some need boosters on a schedule your doctor keeps.
Preventive antibiotics
A daily low-dose antibiotic, usually a penicillin-type medicine, is advised for some people, especially children and those in the first years after surgery or on chemotherapy. Your team decides who and for how long.
The fever rule and stand-by course
Any fever means same-day hospital care. A stand-by antibiotic course at home covers the journey. This layer is the one that saves lives when the first two are not enough.
The card and the telling
A splenectomy card in your wallet, a note on your phone, and a habit of telling every new doctor, dentist and hospital. A doctor who knows you have no spleen acts differently, and faster.
Being straight with you
When is the risk highest, and who is most at risk?
The risk is highest in the first few years after the operation and in young children, and it is higher in people whose spleen was removed for a blood cancer than for an injury. It falls with time but does not reach zero. Someone twenty years on is still at more risk than a person with a spleen.
Other treatment adds to it
Chemotherapy, radiotherapy to the belly, steroids and some targeted medicines all lower the body's defences further. During those periods your team may add antibiotics, delay vaccines until they will work, or set a lower threshold for coming in. Ask what the rule is for you during treatment, because it may be stricter than the lifelong one.
What the numbers cannot tell you
Published figures for how often OPSI happens vary widely between studies, countries and eras, and many come from before modern vaccines were routine. We have not printed a rate because a single number would either frighten you or falsely reassure you. What is not in doubt is that the precautions work, and that the people who come to harm are very often the ones who did not know they needed them.
If you are reading this for a parent who had a splenectomy years ago and was never given vaccines or a card, it is not too late. Book a visit and bring this page.Commonly believed
What families assume about the risk, and what is actually true
"He has had all his vaccines, so he is safe now."
Vaccines lower the risk a great deal, but no vaccine covers every strain and some wear off. The fever rule and the card stay in place for life, vaccinated or not. Think of the vaccines as the first layer, not the whole wall.
"A fever is only serious if it is very high."
Without a spleen it is the speed, not the height, that matters. A modest fever with shivering or feeling suddenly unwell is enough to go in. Waiting to see if the thermometer climbs is the mistake that costs the most.
"Daily antibiotics for years will do more harm than good."
A fair question for your doctor, and the answer differs by age and by the reason for the operation. Where they are advised, the reasoning is that a rare but fast infection is worth a small daily precaution. Do not stop them on your own.
"Only the patient needs to know all this."
The person who drives to the hospital at night needs to know it too. Tell the family what the card says, where the stand-by antibiotics are, and which hospital is nearest. In an emergency the patient is often the one least able to explain.
Questions we are asked
Common questions about infection after splenectomy
How likely is a serious infection, really?
Uncommon in any one year, especially with vaccines and antibiotics in place, but never zero. The concern is less how often it happens and more how fast it moves when it does. That is why the advice is built around speed: recognise the fever, go the same day, say you have no spleen.
What does the start of OPSI feel like?
Usually like flu: fever, shivering, aches, feeling suddenly very unwell. Sometimes vomiting or loose motions. There is often nothing at the start that looks different from an ordinary illness, which is exactly the problem. Treat every such episode as the serious kind until a doctor says otherwise.
Does the risk go away after a few years?
It falls, but it does not disappear. Doctors describe it as lifelong for that reason. The vaccines, the card and the fever rule continue for life. Whether the daily antibiotic continues is a separate decision your team reviews as the years pass.
Am I more likely to catch colds and viral fevers?
Not particularly. The spleen's special job is against a group of bacteria, not against everyday viruses. You will catch the same colds as anyone. The difference is that a bacterial infection can follow a viral one, so a fever during a cold still follows the same-day rule.
Is dengue more dangerous without a spleen?
Dengue is a virus, so the spleen's absence does not change how you catch it. But dengue lowers the platelet count, and a fever in a person without a spleen must still be checked the same day in case bacteria are the cause instead. Do not assume every monsoon fever is dengue.
What should I do about a dog or cat bite?
Wash it well and get it seen the same day, even if it looks trivial. Animal mouths carry a bacterium that can cause severe illness in people without a spleen, and a short course of antibiotics is usually given straight away. The rabies vaccine rules apply as for anyone else.
Does chemotherapy make this worse?
Yes, for the period you are on it. Chemotherapy lowers the white cell count, so you have two reasons to be at risk instead of one. Your oncologist may set a stricter fever rule and add antibiotics during cycles. Some vaccines are delayed until they will work properly.
Should my family members be vaccinated too?
Household members keeping up their own routine vaccines, including the yearly flu vaccine, lowers the chance of bringing infection home. There is no special vaccine for relatives. What matters more is that they know the fever rule and where the card and stand-by antibiotics are.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- NHS — Spleen problems and spleen removal
- National Cancer Institute — Splenectomy (NCI Dictionary of Cancer Terms)
- NHS — Sepsis
- Macmillan Cancer Support — Surgery
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Fever Without a Spleen: Why It Is an EmergencyThe same-day rule in detailVaccinations Before and After SplenectomyThe first layer of protectionPreventive Antibiotics After SplenectomyWho takes them and for how longMalaria, Dengue and Travel Without a SpleenThe mosquito-borne risks in TelanganaComplications and Red FlagsWarning signs after any cancer operation
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Not sure your after-care plan is complete?
Call the helpline or send us your discharge summary. We will check your vaccines, antibiotics, card and fever plan with you. One helpline serves every CION centre.