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absite spleen

QuestionAnswer
2 key roles of spleen Ag processing center for macrophages, producer of IgM
2 types of tissue in spleen and their roles 85% red pulp, removes abnlties in RBC membrane (pitting) and less deformable RBC/senescent (culling); 15% white pulp w immunologic fxn (lymphocyte, macrophages)
what does spleen remove from RBC membrane Howell Jowell bodies (nuclear remnants), Heinz bodies (Hb)
what does white pulp do bacterial clearance that lacks pre-existing Abs; removal of poorly opsonized bac particles and cellular debris
what is tuftsin, fxn and where produced an opsonin, facilitates phagocytosis, made in spleen
what is properdin, fxn and where produced activates alternate complement path, made in spleen
when does hematopiesis occur in spleen before birth and in conditions myeloid dysplasia
where is accessory spleen splenic hilum
indications for splenectomy ITP>TTP, trauma
spleen reservoir for plts, granulocytes
where does Ab production occur within spleen germinal follicles
immune function of spleen filtration/trapping of circulating Ag, lymphocyte stimulation and proliferation; Ab production, production of opsonins (tuftsin and properdin)
etiology of ITP, tx anti plt Ig, in kids <10 present w thrombocytopenia, petichae, gingival bldg; tx=steroids, if resistant plasmophoresis and gammaglobulin (splenectomy only if fail)
etiology TTP, s/s assoc w Rx, infxns, inflamm, autoimmun, loss of plt inhibition leads to thrombosis and infarction w decrsd plt#; purpura, F, AMS, renal dysfxn, hematuria, hemolytic anemia
tx TTP plasmophoresis, 2ry tx steroid and ASA…rarely splenectomy
post splenectomy sepsis, MC bugs, timing, who's at risk <2yr s/p splenectomy, try to wait till kids >5yo, incrsd in kids and splenectomy for hemolytic dz or malignancy; MC bug Spenu, also Hflu and N Mening [should get vaccines for all those beforehand)
how bld work changes s/p splenectomy incrsd RBCs, WBCs, plts
MC splenic tumor hemangioma
when remove splenic cyst if sympt of >10cm
bld labwork hypersplenism decrsd plts, RBCs, WBCs w splenomegaly; resolves w splenectomy
2ry hypersplenism more common than 1ry, usu w incrsd venous P (portal HTN, CHF), malignancy, chronic inflamm dz (Feltys RA), hemo anemias, polycythemia vera; splenectomy if symptomatic
how to tell if intravascular v extravascular hemo anemia intravascular=schistocytes, decrsd haptoglobin, hemoglobulinuria; extravascular (spleen)=spherocytes, helmet
MC congenital hemo anemia requiring splenectomy spherocytosis
cause of spherocytosis spectrin defect (deforms RBC leading to sequestration)
tx spherocytosis splenectomy, chole
pyruvate kinase defic altered glu metabolism, RBC survival incrsd w splenectomy
blood smear indicating G6PD bite cells (where Heinz bodies bitten out by spleen), Heinz bodies
auto immune hemo anemia, lab tests, types MC extracellular from destruction fo cells in spleen or Kupffer cells in liver, can look like hereditary spherocytosis but coombs +; MC Warm AIHA w IgG extravascular (spleen), #2 cold IgM->complement->intravascular in liver
if + direct coombs think warm AIHA
what is the test for cold AIHA cold agglutin
tx warm AIHA if severe steroids, splenectomy if not responsive
tx cold AIHA avoid cold, steroids don't help and neither does splenectomy
why isn't splenectomy needed in sickle cell spleen autoinfarcts
MC type thalassemia is beta
blood smear thalassemia micro anemia, nml Fe studies and nml RDW (all same size), target cells
causes of spont splenic rx mono, malaria, sepsis, sarcoid polycythemia vera
who gets splenic artery aneur females, 2/2 fibromuscular dysplasia
what will a blood smear show w RBCs s/p splenectomy howell jowell (nuclear fragment), Heinz (Hb deposits), Papneheimer bodies (Fe deposits), target cells, spur cells (acanthocytes
what happens to cell lines plts and wbcs s/p splenectomy transient decrs in plt and WBC
Created by: ehstephns on 2013-01-22



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