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Haematology > The spleen > Flashcards

The spleen Flashcards

1
Q

location of spleen

A

left hypochondriac region

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2
Q

relations of spleen

A

visceral surface in contact with stomach,left kidney and tail of pancreas

convex surface lies directly under diaphragm

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3
Q

is spleen easily palpated

A

no

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4
Q

weight of spleen

A

152-250g

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5
Q

length of spleen

A

5-13cm

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6
Q

when can spleen be seen?

A

when enlarged,it moves with respiration

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7
Q

accessory spleens

A

found in 10% of people.

usually a piece of tissue found at any site in the abdomen

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8
Q

when does spleen become palpable

A

if the size exceeds 14 cm

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9
Q

oxygenated blood enters spleen through

A

splenic artery

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10
Q

splenic artery gives off branches?

A

True. branches are called trabecular arteries which enter spleen to form central arterioles

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11
Q

central arterioles become?

A

cords which lack an endothelial lining leading to the formation of an open blood system

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12
Q

what structures line the cord formed by central arterioles

A

loose reticular connective tissue network lined by macrophages and fibroblasts

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13
Q

From the cords how does blood re enter circulation

A

by passing across endothelium of venus sinuses to splenic vein to general circulation

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14
Q

what is the red pulp

A

this is formed by the cords and venus sinuses

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15
Q

volume of red pulp

A

forms 75% of the spleen

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16
Q

function of the red pulp

A

monitors integrity of RBCs. Macrophages pick up old RBCs and destroy them

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17
Q

what surrounds central arterioles

A

White pulp, a core of lymphatic tissue similar to lymph nodes made up of B cells

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18
Q

The white pulp is equivalent to this zone in lymph noded

A

t zone

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19
Q

are all central arteriole to venous connection terminated?

A

No. a minority of them are closed in, presenting with continuous endothelial lining and circulation

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20
Q

Functions of spleen

A

Quality control of RBCs by destroying old ones

Destruction of blood borne pathogens

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21
Q

What is splenomegaly?

A

increase in size of spleen. remember above 14cm

22
Q

How does one detect that there is splenomegaly

A

usually palpable under left costal margin and if exaggerated may be felt as far as right iliac fossa

moves with respiration

medial splenic notch may be palpable

23
Q

causes of splenomegaly

A

hematological disorders

portal hypertension

storage diseases

infections

tropical diseases

systemic disorders

24
Q

hematological causes of splenomegaly

A 
sickle cell dx
chronic myeloid leukemia
chronic lymphocytic leukemia
acute leukemia
hairy cell leukemia
polycythemia vera
thalassemia major/ intermediate
Malignant lymphoma
hemolytic anemia
primary myelofibrosis
25
Q

portal hypertension causes of splenomegaly

A

liver cirrhosis

hepatic, portal, splenic artery thrombosis

26
Q

Storage disease causes of splenomegaly

A

Gauchers disease

Niemann Picks disease

Histocytosis X

27
Q

Infections that cause splenomegaly

A

ACUTE CHRONIC
septicemia Tuberculosis
bacterial endocarditis brucellosis
typhoid syphillis
infectious mononucleosis leshmaniasis
Schistosomiasis

28
Q

Tropical causes of splenomegaly

A

Malaria

29
Q

Systemic diseases that cause splenomegaly

A 
Sarcoidosis
Amyloidosis
Collagen dx
SLE
rheumatoid arthritis
systemic mastocytosis
30
Q

What is hypersplenism?

A

A condition where the spleen is overactive and removes blood cells too quickly.

31
Q

Presentation of hypersplenism

A

Anemia
Enlargement of spleen
reduction of one or more cell lines in peripheral circulation
Bone marrow hyperplasia

32
Q

A normal cell has these amounts of cell lines

A

5% or 50-70mls of RBC

50% of marginating neutrophils

30% of platelet mass

33
Q

A hypersplenic spleen has these amount of cell lines

A

40% of red cell mass

90% of platelets

34
Q

Why will hypersplenism present with anemia

A

This is due to hoarding of RBCs in the spleen leading to low counts in peripheral blood film

35
Q

Many diseases that cause hypersplenism associated with

A

diseases that cause splenomegaly

36
Q

Is hypersplenism a major disease?

A

NO. It is just a clinical sign and a sign of underlying dx

37
Q

Treatment of hypersplenism

A

Treat underlying dx

Splenectomy in cases of severe anemia. Benefits should outweigh risk

38
Q

What is hyposplenism?

A

A reduction in splenic function as a result of various medical conditions. It does a poor job of filtering out old RBCs

39
Q

Why do sickle cell anemia patients present with hyposplenism?

A

There is functional asplenia after 1 year of age - splenic tissue present but doesnt work well

There is anatomical asplenia after 6-8 yrs due to autoinfarction of spleen. Blockage of blood supply to the spleen causes hypoxia and subsequently necrosis

40
Q

Congenital absence of spleen is

A

rare

can occur due to transposition of organ

Malformation of heart and lungs

41
Q

Atrophy of the spleen seen at what age

A

Old age, around 65 yrs

42
Q

Danger for hyposplenic patients

A

Increased susceptibility to infections especially in infants and sickle cell anaemia.

43
Q

Common infections that affect hyposplenic patients

A

S. Pneumoniae

H. Influenza type B

N. Meningitides

Malaria and

Infections caused by bites ( more common in those who have had splenectomy)

44
Q

Causes of hyposplenism

A 
Splenectomy
Sickle cell Anaemia
Splenic arterial thrombosis
Amyloidosis
Adult gluten induced entropathy
Essential thrombocytopenia
45
Q

Red blood cell film features in hyposplenism

A 
Howell Jolly bodies
Acanthocytosis
Irregularly contracted cells
Pappenhaumer bodies
Target cells
Iron granules
46
Q

White blood cell blood film features in hyposplenism

A

Mild lymphocytosis

Monocytosis

47
Q

Platelets blood film count in hyposplenism

A

Thrombocytosis. 30% of platelets that was supposed to be in spleen present in circulation

48
Q

How to prevent infection in Hyposplenic patients

A

Patients should be told about their susceptibility to infection and if possible shouls carry a card around

Prophylactic oral penicillin for life

Vaccination against pneumococcus, influenza, meningococcus etc

49
Q

What drug will you give to patients allergic to penicillin

A

Erythromycin

50
Q

High risk groups that should be given oral penicillin

A

Patients under 16

Patients above 50

Patients who have undergone splenectomy

Patients with a history of previous pneumococcal dx

Haematology (29 decks)

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