Splenectomy is a surgical option for hemolytic anemia. Importantly, there are many risks with splenectomy. These risks must be weighed against the potential benefits.

Splenectomy is a second-line therapy option and is typically done only if there is non-response to steroids. The response rate to splenectomy is usually 60-70%. Splenectomy is ideal for patients with extravascular hemolysis and Fc receptor mediated hemolysis, since the spleen in involved in the pathophysiology of these aspects of hemolytic anemia.^[1]

• Adverse effects: Given that this is a surgery, the risks and benefits must be carefully weighed, as surgical interventions typically have higher risks than medication interventions.
  • Surgical risk: Splenectomy carries an inherent surgical risk. These include alterations in cardiorespiratory status given that general anesthesia must be administered and intubation with mechanical ventilation is usually done.
  • Infections: Splenectomy can be complicated by infections from encapsulated organisms, such as Neisseria meningitides, Streptococcus pneumoniae, and Hemophilus influenzae.^[2] Patients who plan to undergo splenectomy should be vaccinated prior to the surgery. In the current era, the surgical risk of splenectomy is likely lower than in the prior decades, as laparoscopic and minimally invasive approaches are used. Pre-splenectomy vaccinations should be given at least 14 days prior to splenectomy:
    • Give PCV13, wait at least 8 weeks, then give PPSV23
    • Give 2 doses of Menactra or Menveo 2 months apart
    • Give either Trumenba (3 doses administered at 0, 1 to 2, and 6 months) or Bexsero (2 doses administered at least one month apart)
    • Revaccination with PPSV every 5 years
    • Revaccinate with either Menactra or Menveo booster every 5 years
  • Thrombosis: Clot formation is another risk of splenectomy.^[1]