Spleen: Disorders

Abstract

The spleen is an important peripheral immunologic organ although not essential for life. The main functions of the spleen are filtering of blood, lymphopoiesis and immunoglobulin production. The spleen is abundantly supplied with blood, which the other secondary lymphoid organs do not have, and clears particulate material, for example, opsonised bacteria from the blood. Reduced function, known as functional asplenia, is observed in many various pathological conditions, for example, when the spleen is congested with blood or when infiltrated by metastatic tumours or contains large haemangiomas. Most common causes of splenic hypofunction are coeliac disease, sprue, sickle cell disease and haematologic disorders. Individuals with removed spleen or impaired splenic function are prone to serious and often fatal bacterial infections. The vast majority of these serious infections, caused by encapsulated bacteria (pneumococci, meningococci and Haemophilus influenzae type b) can be effectively prevented by immunisations and antibiotic prophylaxis.

Key Concepts

  • Spleen is an important secondary immunologic organ located in the left epigastrium beneath the lower rib cage, responsible for blood filtration and antibodies production.
  • Spleen is important but not essential for life and can be removed.
  • Reduced spleen function, known as functional asplenia, is observed in various pathological conditions including sickle cell disease, celiac disease and haematologic disorders.
  • Spleen dysfunction is associated with increased risk of serious and sometimes fatal bacterial sepsis or meningitis, usually caused by pneumococci and other capsular bacteria.
  • The vast majority of bacterial infections in asplenic individuals can be prevented by currently available immunisations and prophylactic antibiotics.

Keywords: splenectomy; impaired immunity; overwhelming post‐splenectomy infection (OPSI); immune system; immunodeficiency; lymphatic system; vaccination

Figure 1. Basic anatomy of the spleen. Reproduced from U. S. National Institutes of Health, National Cancer Institute.
Figure 2. Transverse section of a portion of the spleen. Reproduced from Gray's Anatomy (1918) – copyrights expired.
Figure 3. The spleen contains two different tissues, white pulp (A) and red pulp (B). The white pulp functions in producing and growing immune and blood cells. The red pulp functions in filtering blood of antigens, microorganisms and defective or worn‐out red blood cells. Reproduced from Wikipedia, file licensed under the Creative Commons Attribution‐Share Alike 4.0 International license.
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Further Reading

Di Sabatino A , Carsetti R and Corazza G (2011b) Post‐splenectomy and hyposplenic states. The Lancet 378 (9785): 86–97.

Feder HM and Pearson HA (1999b) Assessment of splenic function in familial asplenia. New England Journal of Medicine 341: 210–211.

Kuchar E , Miśkiewicz K and Karlikowska M (2015b) A review of guidance on immunization in persons with defective or deficient splenic function. British Journal of Haematology 171: 683–694.

Pearson HA (1998) The spleen and disturbances of splenic function. In: Nathan DG and Orkin SH (eds) Hematology of Infancy and Childhood, 5th, chap 26, edn, pp. 1051–1068. Philadelphia: WB Saunders.

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Kuchar, Ernest, and Karlikowska‐Skwarnik, Monika(May 2017) Spleen: Disorders. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002183.pub2]