Spleen

  • Located in LUQ of abdomen, anterior to left kidney, protected by 9th-11th ribs.
  • Sinusoids are long, vascular channels in red pulp (red arrows in A) with fenestrated “barrel hoop” basement membrane.
  • T cells are found in the periarteriolar lymphatic sheath (PALS) within the white pulp (white arrows in A).
  • B cells are found in follicles within the white pulp.
  • The marginal zone, in between the red pulp and white pulp, contains macrophages and specialized B cells, and is where antigen-presenting cells (APCs) capture blood-borne antigens for recognition by lymphocytes.
  • Splenic macrophages remove encapsulated bacteria.
  • Splenic congestion occurs during a splenic sequestration crisis (marked hemoglobin decrease, rapidly enlarging spleen), which develops due to vaso-occlusion within the cords of Billroth and splenic pooling of erythrocytes.
  • Repeated infarction leads to functional asplenia & autosplenectomy (splenic atrophy)
  • Splenic dysfunction (eg, postsplenectomy state in sickle cell disease): ¯ IgM → ¯ complement activation → ¯ C3b opsonization → ­ susceptibility to encapsulated organisms.
  • Postsplenectomy blood findings:
    • Howell-Jolly bodies (nuclear remnants)
    • Target cells
    • Thrombocytosis (loss of sequestration and removal)
    • Lymphocytosis (loss of sequestration)
  • Vaccinate patients undergoing splenectomy against encapsulated organisms (pneumococcal, Hib, meningococcal)
  • Splenic cyst formation typically occurs due to infection.
  • Spleen is prone to rupture during splenomegaly. Avoid contact sports.

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