Spleen: Consequences of Lack of Function

Abstract

Spleen takes part in maintaining homeostasis in many fields. It acts as a blood filter, a magazine for blood cells as well as immunoglobulins and as an immune response mediator supplying organ. The loss of splenic function can be total or partial, can be congenital or acquired due to chronic diseases affecting its function or through splenectomy. Currently, splenectomy is not a common procedure; it is performed after careful consideration of medical or surgical indications, balancing the risk of longā€term complications against the potential benefit. In patients with lack of adequate splenic function, extended prophylaxis of infectious complications should be planned through vaccinations and antibiotic prophylaxis. Screening for malignancy and thrombotic events should be scheduled.

Key Concepts

  • The spleen is an important secondary immunologic organ located in left epigastrium beneath the lower rib cage.
  • Spleen is important but not essential for life and can be removed by splenectomy.
  • Reduced spleen function, known as functional asplenia, is observed in various pathological conditions including celiac disease, metabolic disorders and blood diseases.
  • The impairment of splenic function significantly increases the risk of serious invasive infections including sepsis and meningitis.
  • The vast majority of bacterial infections in asplenic individuals are caused by capsular bacteria, including pneumococci and meningococci, and can be prevented by currently available vaccines and prophylactic antibiotics.

Keywords: sepsis; immunisations; splenectomy; splenomegaly; hyposplenism

Figure 1. (a) Macroscopic view of the vertical section through spleen showing the entry of blood vessels and meshwork of vascular cords. (b) Schematic diagram of the spleen showing red and white pulp and lymph nodes. (c) Schematic diagram of the circulation in the ‘red pulp’ of the spleen to show both the direct vascular connection and the pathway through sinuses. The ‘white pulp’ with lymph nodes is also represented. (d) CT scan, axial view of the abdomen showing normal spleen on right and liver on left as viewed. Lewis and Swirsky . Reproduced with permission of John Wiley & Sons.
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Further Reading

Arnott A, Jones P, Franklin LJ, et al. (2018) A registry for patients with asplenia/hyposplenism reduces the risk of infections with encapsulated organisms. Clinical Infectious Diseases 67: 557.

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

Kim DK and Hunter P (2019) Advisory committee on immunization practices. recommended adult immunization schedule, United States. Annals of Internal Medicine 170: 182.

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

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

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Kuchar, Ernest, and Karlikowska‐Skwarnik, Monika(Sep 2019) Spleen: Consequences of Lack of Function. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002184.pub3]