Splenic function: Normal, too much and too little

doi:10.1016/0002-9343(79)90554-0

The American Journal of Medicine

Volume 66, Issue 2, February 1979, Pages 311-320

https://doi.org/10.1016/0002-9343(79)90554-0 Get rights and content

Abstract

This review is concerned with normal splenic function, mechanisms and consequences of splenomegaly, hypersplenism, the medical indications for splenectomy and the various aspects of hyposplenism. The potential problem of lethal septicemia in hyposplenic or asplenic patients is also considered.

References (116)

L Weiss
A scanning electron microscopic study of the spleen
Blood
(1974)
P Gavrilis et al.
Correlation of low serum IgM levels with absence of functional splenic tissue in sickle cell disease syndromes
Am J Med
(1974)
AB Bjornson et al.
Decreased opsonization for streptococcus pneumoniae in sickle cell disease: studies on selected complement components and immunoglobulins
J Pediatr
(1977)
JA Winkelstein et al.
Pneumococcal serum opsonizing activity in splenectomized children
J Pediatr
(1975)
WH Crosby
Splenic remodeling of red cell surfaces
Blood
(1977)
SE Lux et al.
Isolation and partial characterization of a high molecular weight red cell membrane protein complex normally removed by the spleen
Blood
(1977)
B Schnitzer et al.
An ultrastructural study of the red pulp of the spleen in malaria
Blood
(1973)
CE Hess et al.
Mechanism of dilutional anemia in massive splenomegaly
Blood
(1976)
Y Yawata et al.
Abnormal red cell metabolism in patients with chronic uremia. Nature of the defect and its persistence despite adequate hemodialysis
Blood
(1975)
LCJ Hartley et al.
Splenectomy for anaemia in patients on regular haemodialysis
Lancet
(1971)

E Bouza et al.

Infections in hairy-cell leukemia

Blood

(1978)

GA Gomez et al.

Splenectomy for palliation of chronic myelocytic leukemia

Am J Med

(1976)

G Joshpe et al.

Transient functional asplenia in sickle cell-C disease

Am J Med

(1973)

BE Brownlie et al.

Thyrotoxicosis associated with splenic atrophy (letter)

Lancet

(1975)

TA Bensinger et al.

Thorotrast-induced reticuloendothelial blockade in man

Am J Med

(1971)

MJ Stone et al.

The clinical spectrum of light chain myeloma

Am J Med

(1975)

JP Atkinson et al.

Complement-independent clearance of IgG-sensitized erythrocytes: inhibition by cortisone

Blood

(1974)

MW Rytel et al.

Possible pathogenetic role of capsular antigens in fulminant pneumococcal disease with disseminated intravascular coagulation (DIC)

Am J Med

(1974)

J Torres et al.

Hyposplenism and pneumococcemia. Visualization of diplococcus pneumoniae in the peripheral blood smear

Am J Med

(1973)

CR Fleming et al.

Splenosis: autotransplantation of splenic tissue

Am J Med

(1976)

EF Ellis et al.

The role of the spleen in immunity. With special reference to the post-splenectomy problem in infants

Pediatrics

(1966)

L-T Chen

Microcirculation of the spleen: an open or closed circulation?

Science

(1978)

GJV Nossal et al.

Antigens in immunity. XII. Antigen trapping in the spleen

Int Arch Allergy

(1966)

DA Rowley

The formation of circulating antibody in the splenectomized human being following intravenous injection of heterologous erythrocytes

J Immunol

(1950)

VV Likhite

Immunological impairment and susceptibility to infection after splenectomy

JAMA

(1976)

ML Schulkind et al.

Effect of antibody upon clearance of I¹²⁵-labelled pneumococci by the spleen and liver

Pediatr Res

(1967)

AD Schwartz et al.

Impaired antibody response to intravenous immunization in sickle cell anemia

Pediatr Res

(1972)

MJ Schumacher

Serum immunoglobulin and transferrin levels after childhood splenectomy

Arch Dis Child

(1970)

A Constantopoulos et al.

Defective phagocytosis due to tuftsin deficiency in splenectomized subjects

Am J Dis Child

(1973)

Z Spirer et al.

Decreased tuftsin concentrations in patients who have undergone splenectomy

Br Med J

(1977)

HN Carlisle et al.

Properdin levels in splenectomized persons

SA Kabins et al.

Fulminant pneumococcemia and sickle cell anemia

JAMA

(1970)

JA Winkelstein et al.

Deficiency of pneumococcal serum opsonizing activity in sickle-cell disease

N Engl J Med

(1968)

RB Johnston et al.

An abnormality of the alternate pathway of complement activation in sickle-cell disease

N Engl J Med

(1973)

RB Johnston

Increased susceptibility to infection in sickle cell disease: review of its occurrence and possible causes

South Med J

(1974)

WA Wilson et al.

Deficiency of factor B of the complement system in sickle cell anemia

Br Med J

(1976)

HP Ward et al.

The natural history of agnogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome

Medicine (Baltimore)

(1971)

CP Holroyde et al.

The “pocked” erythrocyte

N Engl J Med

(1969)

WH Crosby

Hyposplenism: an inquiry into normal functions of the spleen

Ann Rev Med

(1963)

AF LoBuglio et al.

Red cells coated with immunoglobulin G. Binding and sphering by mononuclear cells in man

Science

(1967)

OR McIntyre et al.

Palpable spleens in college freshmen

Ann Intern Med

(1967)

S Sullivan et al.

Reliability of clinical techniques for detecting splenic enlargement

Br Med J

(1976)

F Mitelman et al.

Cytogenetic evidence for splenic origin of blastic transformation in chronic myeloid leukaemia

Scand J Haematol

(1974)

GM Goldberg

Metastatic carcinoma of the spleen resulting from lymphogenic spread

Lab Invest

(1957)

JN McClure et al.

Solitary metastatic carcinoma of the spleen

South Med J

(1975)

JN Miller et al.

An experimental comparison between tumour growth in the spleen and liver

J Path Bact

(1965)

RE Hermann et al.

Splenectomy for the diagnosis of splenomegaly

Ann Surg

(1968)

SG Cassiere et al.

Hairy cell leukemia

Postgrad Med

(1977)

AT Skarin et al.

Lymphosarcoma of the spleen

Arch Intern Med

(1971)

JL Ziegler et al.

Tropical splenomegaly syndrome in a Rwandan kindred in Uganda

Br Med J

(1972)

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¹: From the Hematology-Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.

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ReviewSplenic function: Normal, too much and too little

Abstract

Blood

Am J Med

J Pediatr

J Pediatr

Blood

Blood

Blood

Blood

Blood

Lancet

Blood

Am J Med

Am J Med

Lancet

Am J Med

Am J Med

Blood

Am J Med

Am J Med

Am J Med

The role of the spleen in immunity. With special reference to the post-splenectomy problem in infants

Pediatrics

Microcirculation of the spleen: an open or closed circulation?

Science

Antigens in immunity. XII. Antigen trapping in the spleen

Int Arch Allergy

The formation of circulating antibody in the splenectomized human being following intravenous injection of heterologous erythrocytes

J Immunol

Immunological impairment and susceptibility to infection after splenectomy

JAMA

Effect of antibody upon clearance of I125-labelled pneumococci by the spleen and liver

Pediatr Res

Impaired antibody response to intravenous immunization in sickle cell anemia

Pediatr Res

Serum immunoglobulin and transferrin levels after childhood splenectomy

Arch Dis Child

Defective phagocytosis due to tuftsin deficiency in splenectomized subjects

Am J Dis Child

Decreased tuftsin concentrations in patients who have undergone splenectomy

Br Med J

Properdin levels in splenectomized persons

Fulminant pneumococcemia and sickle cell anemia

JAMA

Deficiency of pneumococcal serum opsonizing activity in sickle-cell disease

N Engl J Med

An abnormality of the alternate pathway of complement activation in sickle-cell disease

N Engl J Med

Increased susceptibility to infection in sickle cell disease: review of its occurrence and possible causes

South Med J

Deficiency of factor B of the complement system in sickle cell anemia

Br Med J

The natural history of agnogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome

Medicine (Baltimore)

The “pocked” erythrocyte

N Engl J Med

Hyposplenism: an inquiry into normal functions of the spleen

Ann Rev Med

Red cells coated with immunoglobulin G. Binding and sphering by mononuclear cells in man

Science

Palpable spleens in college freshmen

Ann Intern Med

Reliability of clinical techniques for detecting splenic enlargement

Br Med J

Cytogenetic evidence for splenic origin of blastic transformation in chronic myeloid leukaemia

Scand J Haematol

Metastatic carcinoma of the spleen resulting from lymphogenic spread

Lab Invest

Solitary metastatic carcinoma of the spleen

South Med J

An experimental comparison between tumour growth in the spleen and liver

J Path Bact

Splenectomy for the diagnosis of splenomegaly

Ann Surg

Hairy cell leukemia

Postgrad Med

Lymphosarcoma of the spleen

Arch Intern Med

Tropical splenomegaly syndrome in a Rwandan kindred in Uganda

Review
Splenic function: Normal, too much and too little

Effect of antibody upon clearance of I¹²⁵-labelled pneumococci by the spleen and liver