Spleen Flashcards
Spleen produces most of which immunoglobulin?
IgM
Difference between red and white pulp?
Red pulp (85%) filter for damaged RBCs (Pitting = removal of abnormalities in RBC membrane, i.e. Howell-Jolly bodies, Heinz bodies; Culling = removal of less deformable RBCs) and White pulp (15%) immunologic function (bacterial clearance, clearance of particles/debris)
What is tuftsin? What is properdin?
Opsonin, facilitates phagocytosis; Activates alternate complement pathway, produced in spleen
How common are accessory spleens? Where are they most commonly found?
20% of population, most often at splenic hilum
What is the pathophysiology of ITP? Treatment?
Drugs, viruses; Caused by anti-platelet IgG antibodies, resulting in decreased platelets, spleen is normal sized; in adults more common women, in children same; ITP usually resolves spontaneously in children <10, otherwise tx w/ steroids, IVIG if steroid resistant; in refractory cases splenectomy (80% respond after splenectomy)
What is the pathophysiology of TTP? Treatment?
Associated with medical reactions, infections, inflammation, autoimmune disease (HUS, ADAMTS13) assoc. with loss of platelet inhibition which leads to thrombosis/infarction, profound thrombocytopenia, tx w/ plasmapheresis (primary) immunosuppression; death due to intracerebral hemorrhage or ARF
Post-splenectomy sepsis syndrome: more common in what population? Most common organisms?
Most common in children (0.1% after splenectomy), higher for splenectomy for hemolytic dz (thalassemia major and sickle cell dz) or malignancy; S. pneumoniae #1, H. influenzas, N. meningitidis - try to wait until children >5
Spherocytosis/elliptocytosis - what is deficient, lab findings, symptoms, and treatment?
Spherocytosis most common congenital hemolytic anemia requiring splenectomy (autosomal dominant); spectrin defect (membrane protein), causes pigmented stones, anemia, splenectomy and cholecystectomy (after age 5); elliptocytosis is a spectrin and protein 4.1 deficit (otherwise similar); Lab findings - Coombs test is negative, mild-moderate anemia, low MCV, elevated RBC width, elevated retics/LDH/unconj. bili, leg ulceration is common
Most common congenital hemolytic anemia not involving membrane protein that require splenectomy?
Pyruvate kinase deficiency
Hodgkin’s lymphoma: staging, what cells are seen, best/worst prognosis?, most common type
type A asymptomatic, type B symptomatic (“B symptoms”) worse prognosis; stage II is 2 non-continuous areas on on same side of diaphragm, stage III involves each side of diaphragm, stage IV is liver/bone/lung or any non lymphoid tissue except spleen, see Reed-Sternberg cells; lymphocyte depleted worse prognosis, lymphocyte predominant best prognosis, nodular sclerosing is most common type – tx w/ chemo
Most common cause of splenic artery/vein thrombosis?
Pancreatitis
Most common splenic tumor?
Hemangioma, splenectomy if symptomatic
Most common malignant splenic tumor?
Non-Hodgkin’s lymphoma
What is Felty’s syndrome?
RA, hepatomegaly, splenomegaly, caused by WBC coated with immune complexes, antibodies vs neutrophil nuclei; leads to neutropenia – TX steroids (to improve neutropenia) splenectomy for symptomatic splenomegaly
How do you manage splenic abscess?
Splenectomy usually; high bleeding risk w/ perc drainage
