Splenectomy Health Article

Definition

Splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system. The spleen is a dark-purple, bean-shaped organ located in the upper left side of the abdomen, just behind the bottom of the rib cage. In adults, the spleen is about 4.8 2.8 1.6 in (12 7 4 cm) in size, and weighs about 4–5 oz (113–142 g). Its functions include a role in the immune system; filtering foreign substances from the blood; removing worn-out blood cells from the blood; regulating blood flow to the liver; and sometimes storing blood cells. The storage of blood cells is called sequestration. In healthy adults, about 30% of blood platelets are sequestered in the spleen.

Purpose

Splenectomies are performed for a variety of different reasons and with different degrees of urgency. Most splenectomies are done after the patient has been diagnosed with hypersplenism. Hypersplenism is not a specific disease but a group of symptoms, or syndrome, that can

be produced by a number of different disorders. It is characterized by enlargement of the spleen (splenomegaly), defects in the blood cells, and an abnormally high turnover of blood cells. It is almost always associated with splenomegaly caused by specific disorders such as cirrhosis of the liver or certain cancers. The decision to perform a splenectomy depends on the severity and prognosis of the disease that is causing the hypersplenism.

Splenectomy always necessary

There are two diseases for which splenectomy is the only treatment—primary cancers of the spleen and a blood disorder called hereditary spherocytosis (HS). In HS, the absence of a specific protein in the red blood cell membrane leads to the formation of relatively fragile cells that are easily damaged when they pass through the spleen. The cell destruction does not occur elsewhere in the body and ends when the spleen is removed. HS can appear at any age, even in newborns, although doctors prefer to put off removing the spleen until the child is five or six years old.

Splenectomy usually necessary

There are some disorders in which splenectomy is usually recommended. They include:

• Immune (idiopathic) thrombocytopenic purpura (ITP). ITP is a disease involving platelet destruction. Splenectomy is the definitive treatment for this disease and is effective in about 70% of chronic ITP cases.
• Trauma. The spleen can be ruptured by blunt as well as penetrating injuries to the chest or abdomen. Car accidents are the most common cause of blunt traumatic injury to the spleen.
• Abscesses in the spleen. These are relatively uncommon but have a high mortality rate.
• Rupture of the splenic artery. Rupture sometimes occurs as a complication of pregnancy.
• Hereditary elliptocytosis. This is a relatively rare disorder. It is similar to HS in that it is characterized by red blood cells with defective membranes that are destroyed by the spleen.

Splenectomy sometimes necessary

In other disorders, the spleen may or may not be removed.

• Hodgkin's disease, a serious form of cancer that causes lymph nodes to enlarge. Splenectomy is often performed in order to find out how far the disease has progressed.
• Thrombotic thrombocytopenic purpura (TTP). TTP is a rare disorder marked by fever, kidney failure, and an abnormal decrease in the number of platelets. Splenectomy is one part of treatment for TTP.
• Autoimmune hemolytic disorders. These disorders may appear in patients of any age but are most common in patients over 50. The red blood cells are destroyed by antibodies produced by the patient's own body (autoantibodies).
• Myelofibrosis. Myelofibrosis is a disorder in which bone marrow is replaced by fibrous tissue. It produces severe and painful splenomegaly. Splenectomy does not cure myelofibrosis but may be performed to relieve pain caused by the swollen spleen.
• Thalassemia. Thalassemia is a hereditary form of anemia that is most common in people of Mediterranean origin. Splenectomy is sometimes performed if the patient's spleen has become painfully enlarged.