The Spleen

Question 1

What are the causes of splenomegaly?

Answer 1

Haematological:
Increased RBC breakdown
Haemolytic anaemias
Acute Leukaemias

Infections:
Malaria
Schistosomiasis
Glandular Fever

Congestive:
Portal Hypertension

Neoplastic:
Tumours
Splenic Abscesses

Question 2

Which are the haematological conditions in which splenectomy improves the condition?

Answer 2

Hereditary spherocytosis and; elliptocytosis as this reduces the breakdown of RBC in reticulo-endothelial system.

Idiopathic thrombocytopenic purpura.

ITP is characterised by the binding of antiplatelet antibodies to platelets followed by phagocytosis by the reticuloendothelial system, mostly in the spleen. Therefore ITP usually improves with splenectomy, it is however a second line treatment due to the complications of splenectomy.

Question 3

What are complications associated with splenectomy?

Answer 3

The main risk is fulminant potentially life-threatening infection. Most common infection is with pneumococcal and carries a significant mortality (60%).

Carries a significantly increased risk of severe falciparum malaria.

Question 4

How should patients who have had a splenectomy be managed?

Answer 4

Full immunisation ideally 2 weeks before the splenectomy then boosters should be given at 5 yearly intervals.

Lifelong prophylactic antibiotics:
Phenoxymethylpenicillin or amoxolcillin

If penicillin allergic: macrolides

Splenectomised patients are at particular risk of pneumococcal infections.

Question 5

What are the potential causes of splenic rupture?

Answer 5

Trauma (high impact blunt trauma, surgical)

Spontaneous rupture in patients with massive splenomegaly (infectious mononucleosis)