Return of splenic function after splenectomy: how much tissue is needed?

Abstract

Ninety patients whose spleen had been removed either because of trauma (41 cases) or as an elective procedure (49) were investigated for return of splenic function by counting pitted red cells and examining spleen scans made after injection of heat damaged 99mTc labelled red cells.There was no significant difference in the proportion of pitted red cells between the two groups of patients. Evidence of splenic tissue in scintiscans was not invariably associated with low pitted 'red cell values, suggesting that the presence of splenic tissue did not necessarily mean return of splenic function. In every patient whose proportion of pitted red cells was less than 16.2% the scintiscan showed splenic uptake. The proportion of patients with pitted red cell values below 16 2% was significantly higher in the group operated on for trauma, and it is concluded that this was due to splenosis. A high inverse correlation between pitted red cell counts and computed splenic volumes was found. Patients with pitted red cell values of less than 16 2% had computed volumes of 22-133 cm3; below this range the proportion of pitted red cells rose very sharply.These results confirm that splenosis occurs in adults, though less often than in children, and suggest that when splenic tissue is to be implanted a graft of at least 20-30 cm3 is needed to ensure satisfactory return of splenic function.

Splenic regeneration following splenectomy and impact on sepsis: a clinical review

“…Corazza et al reported a strong correlation between post{ splenectomy splenic tissue volumes and pitted red values. 34 Their data suggested that 20-30 cm 3 of splenic tissue was the critical value above which pitted cell counts fell below 16%. However, only one case report described a patient who survived pneumococcal sepsis; previously autotransplanted splenic fragments had grown up to five{fold.…”

Formation of Intracellular Vesicles in Neonatal and Adult Erythrocytes: Evidence against the Concept of Neonatal Hyposplenism

“…The assumption that this indicates hyposplenism is based upon experience with a wide variety of disorders in older children and adults in whom impaired splenic function was confirmed by other methodologies (2,23,(41)(42)(43). It has been assumed that adult erythrocytes normally form these vesicles, which are then cleared by the spleen (15,23).…”

Distribuição de Escherichia coli nos órgãos do sistema mononuclear fagocitário após esplenectomia total isolada ou combinada com auto-implante esplênico em rato

“…13 Com base nos achados clinicopatológicos dos implantes esplênicos espontâneos, o implante esplênico autógeno heterotópico passou a ser considerado como uma opção na tentativa de preservar as funções do baço, nos casos em que fosse inevitável a sua retirada. 4,[14][15][16][17] O auto-implante esplênico parece constituir a única alternativa para preservação de tecido esplênico após esplenectomia total. O objetivo deste trabalho foi analisar a depuração sangüínea da Escherichia coli nos órgãos do sistema mononuclear fagocitário (SMF) após esplenectomia total isolada ou combinada com auto-implante esplênico.…”