Splenic function: physiology and splenic hypofunction

RH Sills, JG Kelton - Critical Reviews in Oncology/Hematology, 1987 - Elsevier
RH Sills, JG Kelton
Critical Reviews in Oncology/Hematology, 1987Elsevier
A wide variety of disorders can result in diminished splenic function. The patho-physiology
appears to be clearly defined insome instances, such as congenital a~ Ionia and disorders
of splenic vascular obstruction or congestion. In others, such asthe autolmmune and GI
disorders, the mechanism remains poorly defined. Further re-search is needed. The
hyposplenia whichoccurs in many of these disorders has been associated with an increased
risk of life-threatening, overwhelming bacterialsepsis. In other instances, this complication …
A wide variety of disorders can result in diminished splenic function. The patho- physiology appears to be clearly defined insome instances, such as congenital a~ Ionia and disorders of splenic vascular obstruction or congestion. In others, such asthe autolmmune and GI disorders, the mechanism remains poorly defined. Further re- search is needed. The hyposplenia whichoccurs in many of these disorders has been associated with an increased risk of life-threatening, overwhelming bacterialsepsis. In other instances, this complication has not been reported. This certainly should not be interpreted to mean that itcannot occur. The risk of septicemia in hyposplenic disorders is rarely above 10 to 15%. In disorders with minimal inhibitionof splenic function, the inci- dence of sepsis would presumably be less than the ] .5% incidence following surgicalsplenectomy for trauma. Considvring these data, a very large number of patients would have to become asplcnic before it wouldhe likely that one would develop sepsis. Fur- thermore, the lack of awareness of the possibility of hyposplenia-related sepsisin many of these disorders may cause such occurrences to go unrecognized. Finally, since the risk of sepsis is probably lessin hyposplenic adults as compared to children, studies on adults may underestimate the incidence of this complication inchildren. Many of the disorders reported to cause hyposplenia in adults have not been noted to do so in children. In instancessuch as celiac disease, it may take many years for the complication to manifest so that it would be unlikely for a child tomanifest hypo- splenia during childhood. However, in other instances, not enough children have been studied to be confidenttha~ the hyposplenia and its associated risk of sepsis are not compllcations that occur in children. Hyposplenia-relatedbacterial septicemia is a catastrophic complication. If a patient develops a disorder that is potentially associated withhyposplenia, the patient should he observed for signs of asplenia in the peripheral blood. If the technique is available,quantitation of red cell pits should be performed. If not, other studies of splenic func- tion such as radionuclide scansshould be considered, depending on the incidence of hyposplenia in that particular disorder. If evidence of asplenia develops,pneumocoeeal vaccine should be administered, penicillin prophylaxis should be considered, signifi- cant febrile episodesshould be managed aggressively, and probably most importantly, th~ patient and family should be carefully educated about thiscomplication. Most deaths from hyposplenia-related septicemia are preventable.
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