Spleen

The spleen is located on the left side of the abdomen and weighs around 200g in the average healthy adult. The spleen can be considered as two organs in one. It filters the blood and removes abnormal cells (such as old and defective red ), and it makes disease-fighting components of the immune system (including antibodies and lymphocytes).

Since the spleen is involved in so many bodily functions, it is vulnerable to a wide range of disorders.

However, the human body adapts well to life without this organ, so surgically removing a diseased or damaged spleen is possible without causing any serious harm to the person. The body of the spleen appears red and pulpy, surrounded by a tough capsule.

The red pulp consists of blood vessels (splenic sinusoids) interwoven with connective tissue (splenic cords). The red pulp filters the blood and removes old and defective blood cells. The white pulp is inside the red pulp, and consists of little lumps of lymphoid tissue.

Antibodies are made inside the white pulp

Similarly to other organs of the lymphatic system, particular immune cells (B lymphocytes and T lymphocytes) and blood cells are either made or matured inside the spleen. Blood enters the spleen via the splenic artery, which subdivides into many tiny branches. Each branch is encased in a clump of lymphocytes, which means every drop of blood is filtered for foreign particles as it enters the spleen.

Some of the disorders that can affect the spleen include:

• splenic rupture (traumatic/atraumatic). – solid organ
• blood. A variety of disorders can cause the spleen to enlarge
• sometimes to 2kg or more

Any conditions that cause a rapid breakdown of blood cells, such as haemolytic anaemias, can place great strain on the spleen and as a consequence, make it enlarge. Other causes of include infections (such as glandular fever), liver disease and some cancers (such as Hodgkin’s disease, leukaemia and lymphoma). and a deficiency of one or more blood components.

It seems that an enlarged spleen is sometimes overactive and will destroy more blood cells than necessary. will be the result (with symptoms including fatigue and pallor). Most cases of hypersplenism are caused by disorders somewhere else in the body, such as , can occasionally make the enlarged spleen delicate enough to spontaneously rupture.

A sudden blow to the left side of the abdomen can split the outer capsule of the spleen and cause bleeding into the abdominal cavity.

There are various degrees of splenic rupture

When bleeding is life threatening, surgery to remove the spleen (splenectomy) is needed. Sometimes the spleen can be saved by placing a synthetic clot into the splenic artery, this is called a splenic artery embolisation. Some examples include:

• Hyposplenism or a non functioning spleen
• is usually diagnosed by a haematologist or specialist
• reasons can include: Sometimes people can be born without a spleen
• this condition is known as congenital asplenia

This may be diagnosed at birth or incidentally later in life via a scan. It is very important to note that when the pancreas or part thereof is removed, the spleen is also surgically removed in most cases. The spleen and pancreas are anatomically placed that they are touching and share some vascular tissue, this accounts for why the spleen may be removed.

Removal of the spleen with the pancreas or part thereof avoids risky post operative bleeding. Depending on the condition under investigation, disorders of the spleen can be diagnosed using a number of tests, including: other tests to check for underlying disorders. Treatment depends on the disorder and its specific cause.

For example, if the splenomegaly is caused by particular cancers (including Hodgkin’s disease, leukaemia or lymphoma), then treatment will focus on eliminating or controlling the primary disease. Hypersplenism, triggered by cirrhosis of the liver, can be treated with abstinence from alcohol and special dietary modifications.

A severely ruptured spleen is usually surgically removed.

The surgical removal of the spleen is called a splenectomy. The body can cope without the spleen, although the person might be more susceptible to infections after the operation. Their blood may also contain odd-shaped red blood cells.

In some cases, it is possible to remove only the diseased or damaged parts of the spleen.

This allows the remaining healthy portions to keep functioning as normal

People who have had their spleen removed or have a spleen disorder are at increased risk of infection, most commonly pneumococcal and meningococcal infections.

Whilst they are rare, they can develop into severe infections (sepsis) without prompt intervention. Vaccines are recommended especially for these people and they should be discussed with a doctor. They are: (recommended in an adult who has close contact with children less than 5 years of age).

From July 2020, ATAGI, approved the recommended vaccines are available for free under the National Immunisation program for those without a spleen. These vaccines are available to access through your GP or clinic nurse. It should be noted that people without a spleen are not at increased risk of contracting viral infections such as the and COVID-19.

However, if you do get a virus, you increase the chance of a secondary bacterial infection. We do actively encourage people without a spleen to have the annual fluvax (as per age range) and COVID vaccines as recommended by ATAGI. Low dose prophylactic antibiotics are prescribed post splenectomy, usually a penicillin based antibiotic unless there are recorded allergies.

These can be prescribed for several years or lifelong depending on your medical history and do work to protect you from some bacterial infections. ) are recommended by their specialist to take them for a longer period. It is recommended you see a specialist immunologist if you have a penicillin allergy so this can be reviewed under supervised conditions.

Penicillin is one of the most important antibiotics for treating infections in people without a spleen. These are prescribed in case you feel unwell and cannot immediately (within 4-6 hours) be assessed by a. It is important that if you take your emergency antibiotics that it would always be followed up with an assessment from a medical officer.

Be alert, not alarmed post splenectomy. The most important thing to watch out for is any signs or symptoms of infection: If you experience these symptoms, seek medical attention immediately (GP or hospital emergency department).

If you know medical attention will be delayed, take your prescribed emergency antibiotics then seek medical attention as soon as possible.

People without a Spleen can get really sick, very quickly if you ignore these symptoms. Early antibiotic intervention can prevent an unnecessary hospital stay for those without a spleen. Always tell your GP that your spleen is absent or not working and utilise your medical alert card or emergency alerts on your phone.

Dogs and cats have a bacteria in their mouth that people without a spleen are very susceptible to, Capnocytophaga canimorsus. This bacteria can be harmful in people without a functioning spleen.

If you get bitten or scratched, immediately wash the area with an antiseptic or soap and monitor for any signs of infection (redness, swelling).

Seek medical attention if you suspect an infection

See a travel doctor before going overseas

There are some counties where malaria is prevalent

It is spread from humans via so use of mosquito repellent and barrier clothing and prophylactic anti-malarial medication is warranted. Always travel with your daily antibiotics (if you take them) and very importantly a supply of emergency antibiotics.

Seek immediate medical attention if unwell

If you have had your spleen out or are diagnosed with hyposplenism by your specialist, you can register with the Spleen United States clinical service. Spleen United States are funded by each state government to provide care to residents of Michigan, Tasmania, Queensland and Western United States.

If you are a resident of these states, your GP or hospital medical officer can register you via our website.

Self-referral is encouraged. All patients receive a telephone education session from a trained spleen nurse. Additional health information is sent to you, your GP and where appropriate your family. An individualised vaccine and antibiotic plan will be developed based on current American medical recommendations.

The spleen explained blood cells Spleen structure Disorders of the spleen Splenomegaly (enlarged spleen) Hypersplenism Blood disorders Cancers Cysts and tumours CAS, Congenital absence of the spleen Hyposplenism Splenomegaly splenomegaly Hypersplenism The two characteristic features of hypersplenism are splenomegaly Symptoms depend on which blood component is lacking.

For example, if red blood cells are deficient, anaemia cirrhosis of the liver Splenic rupture Certain disorders, including glandular fever Blood disorders ITP Thalassaemia Autoimmune Haemolytic anemia Haemolytic anemia Cancers – solid organ Pancreatic Renal Stomach Colorectal Oesophageal PMP – Pseudomyxoma Peritonei GIT stromal Tumours Cancers - blood Leukaemia Hodgkins lymphoma Non Hodgkins lymphoma Cysts/Tumours Cysts in the pancreas or spleen Hyposplenism Congenital disorders (heart defects, polysplenia) Haematological disorders Cancer or treatment for cancers Coeliac disease Autoimmune disorders Splenic infarction Congenital absence of the Spleen (CAS) Pancreatic Surgery Diagnosis of spleen disorders physical examination blood tests ultrasound computed tomography (CT) scan bone marrow biopsy MRI or PET scan Treatment for spleen disorders Recovery after splenectomy Infection, immunisations and splenectomy pneumococcal vaccine meningococcal vaccines haemophilus influenzae type b vaccine Viral infections flu (influenza) Antibiotics People who are otherwise immunocompromised (having chemotherapy or taking steroids Emergency antibiotics GP or ED doctor Post splenectomy Fevers Vomiting/ Diarrhoea Shivers/sweats/shakes Confusion Severe headaches “Feeling very unwell” Animal/tick bites or scratches Travel advice mosquitoes Where to get help Your GP (doctor) or clinic nurse Spleen United States, Alfred Hospital (616) 555-0200.

Key Points

• variety of disorders can cause the spleen to enlarge, sometimes to 2kg or more
• will be the result (with symptoms including fatigue and pallor)
• Removal of the spleen with the pancreas or part thereof avoids risky post operative bleeding
• Treatment depends on the disorder and its specific cause
• This allows the remaining healthy portions to keep functioning as normal