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Category Archives: Spleen
Hypersplenism
Hypersplenism
Characterized by triad of:
1. Splenomegaly
2. Anemia, leukocytopenia, thrombocytopenia or a combination of these with hyperplasia of marrow cell precursors of the deficient cell type
3. Correction of blood cytopenias by splenectomy
Pathogenesis
• Increased sequestration of formed elements
• Consequent increased phagocytosis by splenic macrophages
Disorders associated with hypersplenism
• Infections
o Non-specific splenitis related to various blood-borne infections (eg. infective endocarditis)
o Infectious mononucleosis
o TB
o Typhoid fever
o Brucellosis
o CMV
o Syphilis
o Malaria
o Kala-azar
o Histoplasmosis
o Toxoplasmosis
o Trypanosomiasis
o Schistosomiasis
o Leishmaniasis
o Echinococcosis
• Congestive states related to portal hypertension
o Hepatic cirrhosis
o Portal/splenic vein thrombosis
o Cardiac failure
• Lymphohematogenous disorders
o Hodgkin lymphoma
o Non-Hodgkin lymphoma and lymphocytic leukemias
o Multiple myeloma
o Myeloproliferative disorders
o Hemolytic anemias
o Thrombocytopenic purpura
• Immunologic-inflammatory conditions
o Rheumatoid arthritis
o SLE
• Storage diseases
o Gaucher disease
o Niemann-Pick disease
o Mucopolysaccharidoses
• Miscellaneous
o Amyloidosis
o Primary neoplasms and cysts
o Secondary neoplasms
References: Robbins & Cotran Pathologic Basis of Disease, Seventh Edition
by: Vinay Kumar, Nelso Fausto, Abul Abbas
Posted in Spleen
Tagged Anemia, Cytopenia, Hypersplenism, Infections, Leukocytopenia, splenectomy, Splenomegaly, Thrombocytopenia
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Red Pulp Expansion
Benign Causes of Red Pulp Expansion
1. Portal hypertension
2. Sequestration of platelets (eg. ITP)
3. Extramedullary hematopoiesis
4. Cardiac failure
5. Sepsis?
Posted in Spleen
Tagged , Benign Causes of Red Pulp Expansion, red pulp expansion, Spleen
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Splenomegaly
Splenomegaly
Causes of a Large Spleen, Splenomegaly
Infections
Nonspecific splenitis ( acute splenic tumor ) , occurs in any blood borne infection
Infectious mononucleosis ,Tuberculosis , Typhoid fever ,Brucellosis ,Cytomegalovirus ,Syphilis ,Malaria , Histoplasmosis ,Toxoplasmosis , Kala-azar ,Trypanosomiasis ,Schistosomiasis , Leishmaniasis , Echinococcosis (Hydatid cyst)
Congestive States Related to Portal Hypertension
Cirrhosis of the liver, Portal or splenic vein thrombosis ,
Cardiac failure
Lymphohematogenous Disorders
Hodgkin disease, Non-Hodgkin lymphomas/leukemia , Multiple myeloma, Myeloproliferative disorders
Hemolytic anemias, Thrombocytopenic purpura
Immunologic-Inflammatory Conditions
Rheumatoid arthritis, Systemic lupus erythematosus
Storage Diseases
Gaucher disease, Niemann-Pick disease, Mucopolysaccharidoses
Miscellaneous
Amyloidosis
Primary neoplasms and cysts ( Haemangioma, lymphangioma or Hamartomas ), Secondary neoplasms
Complications
- Symptoms : LUQ Dragging sensation or Pain , that could be relay with feeding.
- Hypersplenism ( Please see the Answer of Dr Prashant Jani )
Clinical and hematologic sequelae of Splenectomy
The spleen produces immunoglobulins and initiates the cellular immune response. Phagocytosis and clearance of blood-borne particles, as well as antigen-antibody response, are impaired in asplenic patients. After splenectomy, the immune response to bacterial capsular Type II polysaccharide antigens, which are the antigenic component of the capsule of the encapsulated bacteria ( Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitides), is decreased
Overwhelming sepsis, fatal within 12-24 hours, 60% due to pneumococci (younger age).
Causative organisms Bacteria such as Str. pneumoniae, H. influenza N. meningitidis, Ps. aeruginosa, E. coli and other encapsulated organisms; Protozoa such as Plasmodium and Babesia.
wound infection, lung infection (Atelectasis), Hernia , Bowel obstruction (Adhesions) , Rupture , bleeding, sub-phrenic abscess, Pancreatic and surgical fistula and Splenicula.
Postsplenectomy thrombocytosis may be associated with both hemorrhagic and thromboembolic phenomena (including DVT and PE). Thrombosis of the mesenteric, portal, and renal veins may be a life-threatening as well. increased risk of IHD is also present . The Thrombocytosis may be persistant but usually not more 1000 x 109 / litre. The more complicated picture occurs particularly in patients with myeloproliferative disorders such as CML, essential thrombocytosis, and polycythemia
Initial neutrophilia that regress, Lymphoctosis and Monocytosis may persist.
Red cell examination show variable changes like target cells , Howell-Jolly bodies…etc