Consensus-based recommendation for surveillance of spleen problems

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for spleen problems?

CAYA cancer survivors treated with:

  • splenectomy
  • radiotherapy ≥ 10 Gy to a volume exposing the spleen
  • allogeneic HSCT conditioned with or without TBI
  • autologous HSCT conditioned with TBI

What spleen problems might occur?

  • Overwhelming infections (especially with encapsulated bacteria, e.g. Pneumococcus, Meningococcus, Haemophilus influenzae type B) that could be prevented by vaccination

What other advice should be given?

  • Educate about events that necessitate immediate start of therapeutic antibiotics and prompt evaluation by an HCP

    • fever > 38.3 °C
    • infective or septic symptoms including hypothermia, hypotension, chills/rigors and changes in mental status (e.g. somnolence, agitation)
    • animal or human bite with skin break
  • Ensure that appropriate therapeutic antibiotics are already available or will be rapidly prescribed and dispensed “on demand”, according to local and national policies
  • Follow the current local and national asplenia guidelines concerning prophylactic antibiotics
  • Advise wearing a medical bracelet or carrying a patient card, if available, according to local and national policies
  • Discuss the importance of seeking advice from experts (long-term follow-up team and/or travel vaccine specialists) if the survivor is planning to visit endemic areas about
    • the possible need for travel vaccines
    • the possible need for anti-malarial medications

What should be done if abnormalities are identified?

If CAYA cancer survivors at risk for spleen problems present with fever > 38.3 °C, infective or septic symptoms a or an animal or human bite with skin break, it is recommended to

  • Perform a physical exam
  • Perform a blood count
  • Perform a blood culture
  • Immediately treat with therapeutic antibiotics according to local and national policies until blood culture results are available


While PanCare strives to provide accurate and complete information that is up-to-date as of the date of publication, we acknowledge that the sequence of referral and diagnostic tests might vary according to the local and national healthcare system logistics.

It is recognised that survivors and their healthcare professionals have the final responsibility for making decisions concerning their long-term follow-up care. As such, they may choose to either adopt these recommendations or not to do so after individual informed discussion. It is good practice to document this decision.

In addition to regular surveillance, real-time awareness and prompt reporting of new symptoms and signs is essential to the early detection and timely treatment of late effects.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

a Including hypothermia, hypotension, chills / rigors and changes in mental status (e.g. somnolence, agitation)