Splenectomy is performed in patients with chronic leukemia—including chronic lymphocytic leukemia (CLL), chronic myeloid leukemia (CML), hairy cell leukemia (HCL), and chronic myelomonocytic leukemia (CMML)—to manage hypersplenism, symptomatic splenomegaly, refractory cytopenias, and disease-related complications. The early postoperative period carries significant risks, including reactive thrombocytosis, thromboembolic events, infectious complications, hematological instability, and hemorrhage. This narrative review examines evidence-based approaches to the management of chronic leukemia patients during the early post-splenectomy period (first 30 days). Early management encompasses monitoring of reactive thrombocytosis (which occurs in approximately 75–82% of patients), venous thromboembolism prophylaxis, antimicrobial prophylaxis against encapsulated organisms, hematological monitoring, continuation of disease-specific therapy, and multidisciplinary supportive care. Structured early post-splenectomy management protocols are critical to minimizing morbidity and mortality in this high-risk population, and disease-specific nuances must be integrated into individualized care plans.

Splenectomy; chronic leukemia; post-splenectomy management; reactive thrombocytosis; venous thromboembolism prophylaxis; overwhelming post-splenectomy infection; hypersplenism.

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