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42 Cards in this Set

  • Front
  • Back
What are Howell-Jolly bodies?
nuclear remnants (clusters of DNA) from RBCs
The spleen provides both nonspecific and specific immune responses. What are the 2 arms of the non-specific response?
• clearance of opsonized particles and bacteria by fixed splenic macrophages
• opsonin production
What is an opsonin?
any molecule that acts as a binding enhancer for the process of phagocytosis
What some opsonins produced by the spleen and what are their specific functions?
• fibronectin
• properdin: activated the alternative pathway of the complement system
• tuftsin: facilitates macrophage phagocytosis
What is the most useful imaging technique to determine splenic size and detect injury?
CT scan
What are indications for splectomy?
• hematologic disorders
• hypersplenism (associated with other disease)
• leukemia & lymphoma
• splenic rupture
• other (ex. abscess, tumors, cysts, splenic artery aneurysm)
What are examples of hematologic disorders that could be treated by splenectomy?
• hemolytic anemias
• hereditary spherocytosis
• hereditary elliptocytosis
• thalassemia minor & major
• thrombocytopenia
What is the most common reason for splenectomy?
True/False: The spleen is the most commonly injured organ after blunt abdominal trauma
The correct answer is: True
True/False: The spleen is the most commonly injured organ after penetrating abdominal trauma
• The spleen is the 2nd most commonly injured organ after penetrating abdominal trauma
• The correct answer is: False
What are the 3 general mechanisms of splenic injury?
• penetrating
• blunt compressive
• blunt deceleration
Describe a grade I splenic injury
• hematoma: subcapsular < 10% surface area
• laceration: < 1 cm deep
Describe a grade II splenic injury
• hematoma:
- subcapsular 10%-50% surface area
- parenchymal < 5 cm diameter

• laceration: 1-3 cm deep, not involving trabecular vessels
Describe a grade III splenic hematoma
• hematoma:
- subcapsular > 50% surface area
- parenchymal > 5 cm diameter
- hematoma can be expanding or ruptured

• laceration: > 3 cm deep or involving trabecular vesselsq
Describe a grade IV splenic injury
laceration of segmental vessels inovlved with devascularization < 50%
Describe a grade V splenic injury
• completely shattered spleen
• hilar vascular injury with devascularization
What is a Kehr's sign?
severe left shoulder pain in patients with splenic injury (due to referred pain from diaphragmatic irritation)
What is a Ballance's sign?
percussion dullness of the left flank in patients with splenic injury
What is a splenorrhaphy?
operative repair of the spleen
What is the most common reason for an asplenic state?
Differentiate between hypersplenism and splenomegaly
• hypersplenism is excess function of the spleen
• splenomegaly is anatomic enlargement of the spleen
What are characteristics of hypersplenism?
• cytopenia: anemia, leukopenia, & thrombocytopenia (either alone or in combination)
• normal or hyperplastic cellular precursors in bone marrow
How does hypersplenism cause cytopenia?
• increased sequestration of the cells in the spleen
• increased destruction of cells by the spleen
• production of antibodies in the spleen, leading to increased sequestration and destruction
What is hereditary spherocytosis?
• a deficiency in spectrim (a membrane component that is essential for deformability)
• RBC are rigid and cannot pass into the splenic sinuses and become sequestered in the red pulp
What are examples of hemolytic anemias caused by metabolic abnormalities?
• pyryvate kinase deficiency
• glucose-6-phsophate dehydrogenase (G6PD) deficiency
True/False: Hemolytic anemias caused by metabolic abnormalities are not responsive to splenectomy
The correct answer is: True
What are examples of hemoglobinopathies that can be treated with splenectomy?
• Sicke cell (more useful early in the disease)
• Thalassemias (are at high rish for overwhelming postsplenectomy infection)
Patients with autoimmune hemolytic anemia (Coob's test positive) are treated first-line with corticosteroids and treatment for any unerlying disorders. When would splenectomy be indicated in these patients?
• when steroids are ineffective
• when high doses are required
• when toxic side effects develop during steroid treatment
Which type of autoimmune hemolytic anemia is more likely to respond to splenectomy, anemias associated with warm reactive antibodoes (IgG) or cold reactive antibodies (IgM)?
Warm reactive antibodies (IgG)
What is the treatment for ITP?
• corticosteroids (inital treatment)
• splenectomy (if unresponsive to corticosteroids)
What are clinicial features of TTP?
• fever
• purpura
• hemolytic anemia
• neuroligc manigestations
• signs of renal disease
When is splenectomy indicated for hypersplenism?
• platelet count is < 50,000 with evidence of bleeding
• neutrophil count is < 2000
• pt has anemia requiring blood transfusion
What is Felty's syndrome?
• neutropenia
• rheumatoid arthritis
• splenomegaly
When is splenectomy performed to treat Felty's syndrome?
when severe recurrent infection or intractable leg ulcers occur
True/False: Splenectomy is not indicated for acute leukemia
The correct answer is: True
When is splenectomy indicated for chronic leukemia?
• for some cases of hypersplenism
• for symptoms associated with massive splenomegaly
What are hematologic changes that occur after splenectomy?
• WBC increases (usually returns to normal in 5-7 days)
• peripheral smear shows Howell-Jolly bodies, Pappenheimer bodies, & pitted red cells
• platelets increase (usually returns to normal in 2 weeks)
Which patients are at the highest risk of postsplenectomy sepsis?
patients who undergo splenectomy for hematologic disorders
Overwhelming infections in post-splenectomy patients are usually caused by encapsulated organisms. List examples of encapsulated organisms.
• Strep pneumoniae (most common)
• H. flu
• N. meningitidis
• ß-hemolytic strep
• Staph aureus
• E. coli
• Pseudomonas
What are examples of parasitic inections that can cause an overwhelming infection in a post-splenectomy patient?
• Babesiosis
• Malaria
What are vaccines that should be given to after splenectomy?
• polyvalent pneumococcal polysaccaride vaccines
• H. Flu vaccine
• N. meningitidis vaccine
What is the most common problem after splenectomy?