Don’t be mean to the spleen

The spleen gets very little respect.  It was thought in ancient times that the spleen was the seat of emotions and passion, ill temper and melancholy.  Hence, the phrase “to vent one’s spleen”.  Like the appendix, one can live without a spleen.

Because the spleen is considered a “non-vital” organ, it is often overlooked until it’s affected by a specific infectious disease process or a traumatic injury.  The spleen is located in the left upper quadrant of the abdomen, just under the ribcage.  Its protected location suggests that it is indeed an important organ.  Its shape is a somewhat flattened oval, about the size of a fist.

The spleen plays important roles in regard to blood cells and immunity.  It is considered part of the lymphatic system, like a giant lymph node.  

Our red blood cells (RBC) only last about 120 days.  One of the jobs of the spleen is to remove old RBC’s from circulation and recycle the iron-containing hemoglobin from the cells.  In this way, the spleen acts as an RBC filter.  The hemoglobin is further degraded by the liver and the iron-containing portion can be reused to make new blood cells.

The spleen is also a storage site in the body.  It can store red blood cells, white blood cells, and platelets.  It can hold about 250 milliliters of blood.  If an individual is losing blood or going into shock, the spleen can assist by sequestering a small reserve.  

In regard to immunity, the spleen can make antibodies, proteins that are used to fight off infection.  However, most of the body’s antibodies are made by the circulating blood cells (white blood cells, WBC).  Germs, such as bacteria, that are coated with antibodies can be removed from the circulation and destroyed by the spleen.  It is also one site of lymphocyte formation.  Lymphocytes are one type of WBC used to fight viral infections.  

One of the most common disorders of the spleen is splenomegaly.  Splenomegaly is simply enlargement of the spleen.  This can occur in response to an infection, liver disease, sickle cell disease, blood clots, blood cancers (leukemia), or other metabolic diseases.  One condition in which this is commonly seen is mononucleosis.  This viral infection can cause spleen enlargement; those afflicted must be careful not to damage the spleen through contact, such as with sports.

On the other side of common disorders affecting the spleen is trauma.  Motor vehicle accidents, contact sports, falls, all of these can produce blunt force that can damage the spleen.  The spleen can be simply bruised or, with more significant force, it can be lacerated.  Symptoms include pain in the left upper abdomen and left shoulder, abdominal fullness, fatigue, and anemia.       

Lacerations of the spleen can be mild (grade I) to severe (grade V).  In the past, more severely damaged spleens were surgically removed immediately (splenectomy).  However, in recent years, partly because of the recognition of the importance of the spleen in fighting infection, even grade III and IV lacerations can be treated conservatively in low risk individuals.

Those who have their spleen taken out are at greater risk than the general population for certain types of bacterial infections.  Vaccination for pneumococcus, meningitis, and haemophilus are recommended in these individuals.       

The content in this column is for informational purposes only.  Consult your physician for appropriate individual treatment.  Dr. Reynolds practices Family Medicine in Chesterfield.

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