This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.

Spleen problems (reduced spleen function)

The spleen is an organ in the upper abdomen, just behind the stomach. The most important function of the spleen is to store white blood cells before they are released into the bloodstream. White blood cells are needed to fight infections.

Sometimes problems can occur with the spleen and weaken the immune system. This may lead to frequent infections. In particular, infections caused by bacteria (for example Pneumococcus, Meningococcus, and Haemophilus Influenzae type B) may occur more often.

Am I at higher risk of reduced spleen function?

Anyone, including people who have never had cancer treatment, may develop reduced spleen function. However, there are some cancer treatments that may increase the risk of having reduced spleen function later in life.

The following treatments can increase the risk of reduced spleen function:

  • Surgery that involves removal of the spleen
  • Radiotherapy to the spleen or an area that includes the spleen (10 Gy or more)
  • Stem cell transplantation with stem cells from a donor (allogeneic) with or without total body irradiation
  • Bone marrow transplantation with your own bone marrow (autologous) together with total body irradiation

You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you experience reduced spleen function, it does not always mean that this is caused by your cancer treatment. Reduced spleen function may have other causes.

What are the symptoms and signs of reduced spleen function?

There are symptoms and signs that can tell you if you might have a reduced spleen function. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

A common sign of reduced spleen function is frequent bacterial infections. Symptoms and signs of infections are:

  • Fever (38.3 °C or higher)
  • Severe bacterial infections may also cause very high fever (39.5 °C or higher) or hypothermia (35 °C or lower), chills and/or tremors, and drowsiness or sleepiness

If you have been experiencing frequent bacterial infections, please contact your general practitioner or follow-up care specialist.

I am at higher risk of reduced spleen function. What tests should I have and when?

If you are at higher risk of spleen problems, regular testing is not necessary.

What happens if I have reduced spleen function?

If you have reduced spleen function, it is important to know about vaccinations and (prophylactic) antibiotics. Both of these things can reduce the frequency and severity of infections caused by bacteria (for example Pneumococcus, Meningococcus, and Haemophilus Influenzae type B).

Additionally, you may need to have travel vaccines and protective anti-malarial medications if you are travelling to an area where these infections are present.

Please ask your general practitioner or follow-up care specialist whether you need vaccinations or protective antibiotics.

What happens if I experience symptoms and signs of reduced spleen function?

If you have reduced spleen function, it is important to see a doctor urgently when you have:

  • a fever (38.3 °C or higher)
  • symptoms and/or signs of an infection
  • been bitten by an animal or human and the skin has been broken

The doctor may then decide to:

  • Do a physical exam
  • Do blood tests including a blood count (to look at the effect of the infection) and a blood culture test (to look for bacteria present in the bloodstream)

It may take a while before the results of the blood culture test are ready. However, in the meantime, the doctor may prescribe you antibiotics whilst waiting for the results.

To prevent infections from occurring or worsening in the future, prophylactic antibiotics may be needed.

What else can I do?

Experiencing spleen function can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

If you have reduced spleen function, you may want to consider wearing a medical bracelet or carrying a patient card. In addition, if you plan to travel to countries with malaria, it is important to seek advice from your general practitioner or follow-up care specialist first. You may need travel vaccinations or medication to protect you against malaria.

Although it may not influence spleen problems, it is still important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

It is important that you are aware of the possibility of developing spleen problems and that you know the symptoms and signs. It is also important that you know the symptoms and signs of infections. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about reduced spleen function online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

  • Together: Here you can find more information about spleen problems in general

On this website, you can also find more information related to this topic:

Please note

This PLAIN summary is based on the PanCareFollowUp guideline about “Spleen problems” [1], which is based on the consensus of different national guidelines.

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

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.

[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext