as given by Dr. Schultz

1. Spleen

2. Pulp
• Red: 85%, filters damaged RBCs
– Howell Jolly bodies (nuclear remnants)
– Heinz ( Denatured Hgb)
– Pappenheimer (Iron)
– Target Cells (Immature RBCs)
• White: 15%, immunologic function
– Lymphoid Follicles: B-bells
– Peri-arteriol lymphatic sheath: T-Cells
– Produces IgM/IgG
• Major site of IgM
– Opsonized pathogens

3. Heinz Bodies
Howell-Jolly Bodies
Pappenheimer Bodies

4. Splenectomy Indications
• Trauma
• Refractory ITP (MC non traumatic indication)
• Hereditary spherocytosis
• Hodgkin’s/NHL
• Cysts/Abscesses

6. ITP
• Autoimmune secondary to drug/virus exposure
• IgG against GPIIb/IIIa
• Sx: Petechia, gingival bleeding
• 90% will spontaneously resolve if < 10 y.o.
• Tx: Steroids, IVIG
– Splenectomy: If medical management fails at 3-6 months,
pt has a recurrence, or prolonged steroids
• Persistent thrombocytopenia
– Look at blood smear for asplenic changes – howell-jolly,
Heinz, pappenheimer
– If not present, look for accessory spleen – RBC scan

7. Hereditary Spherocytosis
• Spectrin deficiency  deformation  splenic
sequestration hypersplenism
• Usually children
• Sx: Anemia, jaundice, splenomegaly,
pigmented gallstones
• Tx: splenectomy if symptomatic and >6 years
old
– Do cholecystectomy at the same time

8. TTP
• Low platelets, AMS, Renal failure, Fever,
hemolytic anemia
• Splenomegaly
• 80% have decreased enzyme ADAMTS13
(supposed to clear vWF)
• Tx is plasmapheresis (clears vWF), steroids –
80% response rate
– No medical response - splenectomy

9. Miscellanous Lesions
• Splenic Cyst
– 5cm or symptomatic = laparoscopic cyst excision or
fenestration
• Hemangioma
– Symptomatic= splenectomy
• Angiosarcoma
– Vinyl Chloride, thorium dioxide
• Wandering Spleen
– Splenectomy vs Splenopexy

10. Splenic Artery Aneurysm
• Most common visceral aneurysm
• W:M 4:1
• Middle to distal portion of splenic artery
• Risk of rupture 3-9%, mortality after rupture 35-
50%
• Double Rupture
• Indications for surgery: symptoms, pregnancy,
intent to become pregnant, >2cm
– Coil Embolization
– Distal: Splenectomy

11. Splenic Abscess
• Unilocular, thick wall, stable patient
– IR drain
• Multilocular, thin wall, echinococcal,
unstable/sick patient
– Splenectomy

12. OPSI
• Lifetime risk: 1-2%
• Risk factors: <5yo, within 2 years of
splenectomy, Beta-Thalassemia
• Encapsulated organisms (loss of opsonization)
Strep Pneumococcus (MC), H Flu, Neisseria
• Kids <10yo give prophylactic Augmentin

13. Fun Facts
• After splenectomy: increased RBCs, WBCs, Plts
– Tx for increased plts (>1million): ASA
– Liver will takeover some of splenic functions
• MC location of accessory spleen: hilum
• MC splenic tumor: hemangioma
• MC malignant tumor: NHL
• MCC splenomegaly: NHL