Mitchell Lewis, Hammersmith Hospital, London, UK
David Swirsky, Leeds General Infirmary, Leeds, UK
Published online: September 2005
DOI: 10.1038/npg.els.0004020
Loss of splenic function may be absolute or partial; it may be primary (e.g. splenectomy) or secondary to a range of medical disorders. The haematological effects and clinical complications depend on the extent to which various functions are compromised. The most serious complication, requiring lifelong control, is overwhelming postsplenectomy infection (OPSI).
Keywords: hyposplenism; asplenia; spleen function; splenuncule; postsplenectomy infection
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Figure 1.
(a) Macroscopic view of 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 abdomen showing normal spleen on right and liver on left as viewed. Courtesy of Dr Mark Paley, Hammersmith Hospital, London. |
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Figure 2.
Blood film showing features of hyposplenism: Howell–Jolly bodies and a normoblast, contracted cells, polychromatic cells and pitting. |
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Figure 3.
(a) CT scan, axial view of abdomen showing enlarged spleen infiltrated by sarcoma. (b) MRI scan, axial view of abdomen showing normal spleen. (c) MRI scan; same case as (b) at a different setting; note the pancreas in (b) and (c). Courtesy of Dr Mark Paley, Hammersmith Hospital, London. |
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Figure 4.
Imaging over the torso after administration of radionuclide‐labelled red cells. The markings indicate the xiphisternum and lower costal margin. (a) Autologous normal cells, showing red cell pool in the spleen and blood flow in the heart; anterior view. (b) Heat‐damaged red cells to demonstrate functionally normal spleen which is not palpable below the costal margin; anterior view. (c) Heat‐damaged red cells have been taken up only in the liver, indicating hyposplenism; anterior view. (d) Heat‐damaged red cells have been taken up predominantly in the liver, but there is also a small functionally active splenuncule that is visualized better on posterior view. |
References
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Further Reading
Bowdler AJ (ed.) (2002) The Complete Spleen: Structure, Function and Clinical Disorders. Totowa, NJ: Humana Press.
Harrington WJ Jr, Harrington TJ and Harrington WJ Sr (1990) Is splenectomy an outmoded procedure? Advances in Internal Medicine 35: 415–440.
Lewis SM (1999) The spleen. In: Hoffbrand AV, Lewis SM and Tuddenham EGD (eds) Postgraduate Haematology, pp. 323–335. Oxford: Heinemann.
Lewis SM and Swirsky D (1996) The spleen and its disorders. In: Weatherall DJ, Ledingham JGG and Warrell DA (eds) Oxford Textbook of Medicine, pp. 3587–3596. Oxford: Oxford Medical Publications.
Sills RH (1989) Hyposplenism. In: Pochedly C, Sills RH and Schwartz AD (eds) Disorders of the Spleen: Pathophysiology and Management, pp. 99–144. New York: Marcel Dekker.
Spencer RP and Pearson HA (1975) Radionuclide Studies of the Spleen. Cleveland, OH: CRC Press.
Sty JR and Conway JJ (1985) The spleen: development and functional evaluation. Seminars in Nuclear Medicine 15: 276–298.
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