Spleen: Consequences of Lack of Function

Ernest Kuchar, Medical University of Warsaw, Warszawa, Poland
Monika Karlikowska‐Skwarnik, Uniwersytet Medyczny im Piastow Slaskich we Wroclawiu, Wrocław, Poland

Published online: September 2019

DOI: 10.1002/9780470015902.a0002184.pub3

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 long‐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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References

Bolze A, Mahlaoui N, Byun M, et al. (2013) Ribosomal protein SA haploinsufficiency in humans with isolated congenital asplenia. Science 340: 976–978.

Buffet P, Milon G, Brousse V, et al. (2006) Ex vivo perfusion of human spleens maintains clearing and processing functions. Blood 107 (9): 3745–3752.

Buzele R, Barbier L, Sauvanet A and Fantin B (2016) Medical complications following splenectomy. Journal of Visceral Surgery 153 (4): 277–286.

Cerutti A, Cols M and Puga I (2013) Marginal zone B cells: virtues of innate‐like antibody‐producing lymphocytes. Nature Reviews Immunology 13: 118–132.

Craddock CG, Longmire R and McMillan R (1971) Lymphocytes and the immune function. New England Journal of Medicine 285: 378–384.

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

Ivemark BI (1955) Implications of agenesis of the spleen on the pathogenesis of the conotruncus anomalies in childhood. Acta Paediatrica 44 (supplement 104): 1–110.

Kim CH (2010) Homeostatic and pathogenic extramedullary hematopoiesis. Journal of Blood Medicine 1: 13–19.

Kirkineska L, Perifanis V and Vasiliadis T (2014) Functional hyposplenism. Hippokratia 18 (1): 7–11.

Kristinsson SY, Gridley G, Hoover RN, Check D and Landgren O (2014) Long‐term risks after splenectomy among 8,149 cancer‐free American veterans: a cohort study with up to 27 years follow‐up. Haematologica 99 (2): 392–398.

Lecturio (2016) The Spleen – Central Organ of the Lymphatic System. https://www.lecturio.com/magazine/spleen/

Lewis M and Swirsky D (2005) Spleen: consequences of lack of function. eLS. John Wiley & Sons, Ltd.

Mebius R and Kraal G (2005) Structure and function of the spleen. Nature Reviews Immunology 5: 606–616.

Rialon KL, Englum BR, Gulack BC, et al. (2016) Comparative effectiveness of treatment strategies for severe splenic trauma in the pediatric population. American Journal of Surgery 212: 786–793. DOI: 10.1016/j.amjsurg.2015.06.009.

Swirski FK, Nahrendorf M, Etzrodt M, et al. (2009) Identification of splenic reservoir monocytes and their deployment to inflammatory sites. Science 325: 612–616.

Toutouzas KG, Velmahos GC, Kaminski A, Chan L and Demetriades D (2002) Leukocytosis after posttraumatic splenectomy: a physiologic event or sign of sepsis? Archives of Surgery 137 (8): 924–929.

William B and Corazza G (2007) Hyposplenism: a comprehensive review. Part I: basic concepts and causes. Hematology 12 (1): 1–13.

William B, Thawani N, Sae‐Tia S and Corazza GR (2007) Hyposplenism: a comprehensive review. Part II: clinical manifestation, diagnosis, and management. Hematology 12 (2): 89–98.

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.

Mohamed M (2014) Functional hyposplenism diagnosed by blood film examination. Blood 124 (12): 1997.

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.

Related Sub-Topics:

Diagnostics, Therapeutics and Methods | Immunodeficiency | Tissues of the Immune System
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Article Title: Spleen: Consequences of Lack of Function
 
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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]