Splenomegaly, Hypersplenism & Hyposplenism

Question 1

Hyposplenism aetiology (3 examples)

Answer 1

• Splenectomy
• Coeliac disease
• Sickle cell disease

Question 2

What features would you expect in the blood film of an individual with hyposplenism/ post-splenectomy & why do they occur

Answer 2

Howell-Jolly bodies
& Pappenheimer bodies

=> do to reduced red pulp function

Question 3

What are Howell-jolly bodies

Answer 3

Basophilic nuclear remnants, often seen with decreased splenic function

Question 4

What other features (non red pulp related) would you possibly find in patients (particularly children) who have had a splenectomy

Answer 4

Immune deficiency

Question 5

Post splenectomy management

Answer 5

Vaccinations
Prophylaxis low dose antibiotics

Question 6

What are indications for splenectomy

Answer 6

• Emergency splenectomy (due to trauma/rupture)
• Elective splenectomy (due to hypersplenism) (where spleen increases platelet uptake) (e.g. in haemolytic anaemia or ITP)

Question 7

Splenomegaly aetiology

Answer 7

Infections e.g. EBV, TB, malaria
Portal congestion e.g. cirrhosis, portal vein thrombosis, HF
Haematological malignancy e.g. lymphoma/leukaemia/MPN
Other haematological disease e.g. haemolytic anaemia
Autoimmune e.g. RA, SLE
Storage disorders
Miscellaneous e.g. amyloidosis, cysts

Question 8

Splenomegaly clinical features

Answer 8

• Dragging sensation in LUQ
• Early satiety
• Discomfort with eating
• Pain if infarction

Question 9

What is the triad of hypersplenism

Answer 9

1. splenomegaly
2. fall in one/ more cellular blood components (cytopenias)
3. correction of cytopenias by splenectomy