haematology: spleen

Question 1

What is the anatomy of the spleen (size & shape)

Answer 1

Wedge shapes encapsulated organ
8-13 cm & 100-150g

Question 2

Where do you find the spleen

Answer 2

Left upper quadrant of abdomen, behind 9th – 11th ribs & in peritoneal cavity
Adjacent to stomach, colon & left kidney

Question 3

What is the blood supply & drainage of the spleen

Answer 3

Blood supply: splenic artery branching from coeliac artery
Blood drainage: splenic vein that drains into portal vein

Question 4

What is the two main functions of the spleen

Answer 4

1. White pulp: lymphoid function for antibody production
2. Red pulp: phagocytic function of abnormal/senescent RBC & generate components that are recycled

Question 5

What is an abnormally enlarged spleen called

Answer 5

Splenomegaly

Question 6

What is hypersplenism

Answer 6

Enlarged spleen with rapid & premature destruction of blood cells causing cytopenia of 1/+ cell lines

Question 7

What is the grading system for splenomegaly

Answer 7

Mild: < 4cm from costal margin
Moderate: 4-12cm from costal margin
Massive: > 12cm from costal margin

Question 8

What is the seven causes of splenomegaly

Answer 8

1. Haematological malignancies
2. Extramedullary haematopoiesis
3. Infection
4. Storage disease
5. Immune disorder
6. Non-haematological malignancies
7. Congestion

Question 9

What is the mechanisms of extramedullary haematopoiesis with an example

Answer 9

Bone marrow pathology or long standing stressed haematopoiesis
Chronic anaemia in thalassemia

Question 10

What is the mechanisms of congestion with an example

Answer 10

Elevated splenic venous blood pressure leading to spleen distended with blood
Portal hypertension

Question 11

What is the mechanisms of infection with an example

Answer 11

White pulp distended due to immune response
Red pulp distended due to increase blood flow & activation of macrophages
TB, EBV & CMV

Question 12

What is the mechanisms of immune disorder with an example

Answer 12

White pulp distended due to lymphoid role in immunity
SLE

Question 13

What is the mechanisms of haematological malignancies with an example

Answer 13

Malignant cells infiltrate marrow
Acute leukaemia

Question 14

What is the mechanisms of non-haematological malignancies

Answer 14

Rarely infiltrated by other malignancies

Question 15

What is the mechanisms of storage disease

Answer 15

Amyloid depositions that causes macrophages to be distended with abnormal storage products