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SPLEEN (Disorders (Hypersplenism (Peripheral blood pancytopenia &…

- - - - When spleen is overactive, it removes RBCs too early & quickly.
      - Many blood cells are being polled and destroyed in the spleen reticulo -endothelial system
    - - Massive splenomegaly & pancytopaenia
      - Treated by Splenectomy
  - - - RBC abnormalities
        
        Sickle cell anaemia
        
        Hereditary Spherocytosis
      - Immune disorders
        
        Systemic Lupus Erythematosus
        
        Fenty's syndrome
        
        Rheumatoid arthritis & splenomegaly
      - Congestion
        
        Capsule is thickened and fibrotic
        
        Cut surface:
        
        Scattered firm brown nodules
        
        Composed of fibrous & elastic tissue with abundant haemosiderin & dystrophic calcification
        
        Gamna Gandy bodies
        
        These represent areas of healed infarction
        
        Beefy red color with unnoticeable white pulp
        
        Enlarged spleen which reach kg
        
        Caused by persistent elevation of splenic venous blood pressure
        
        Due to:
        
        Hepatic
        
        Cirrhosis
        
        Post-Hepatic
        
        (+) pressure in IVC
        
        Asso. with ascites & hepatomegaly
        
        Causes:
        
        Decompensated heart failure
        
        Pulmonary/tricuspid disease
        
        Pre-Hepatic
        
        Thrombosis of the extrahepatic portion of the portal vein / splenic vein
      - Primary / Metastatic neoplasms
        
        Acute & chronic leukemia
        
        Myeloproliferative disorders
        
        Bone marrow makes too many abnormal RBCs, WBCs / platelets which accumulate in blood.
        
        Haemangioma
        
        Beningn
        
        Collection of small blood vessels that form a lump under the skin
        
        Hodgkin's Lymphoma
        
        Non-Hodgkin's lymphoma
      - Infection
        
        Viral Disease
        
        Produces sudden & therefor more severe splenomegaly
        
        Susceptible to rupture
        
        Infectious Mononucleosis
        
        Bacterial Infection
        
        Neutrophils accumulate in the sinuses & medullary cords
        
        If extreme can lead to Acute Septic Splenitis
        
        Which is neutrophilic infiltrate & congestion within the red pulp accompanied by splenomegaly
        
        In response to infections like bacterial endocardititis or localised abscesses
        
        Spleen becomes soft bcoz of proteolytic enzymatic action
        
        Chronic Malarial Infection
        
        Splenic capsule is thickened & fibrotic
        
        Cut surface is grey due to malarial pigment
        
        Massive splenomegaly
        
        Systemic Infection
        
        Congestion & macrophage hyperplasia
        
        White pulp prominent
        
        Moderate splenomegaly
        
        Granulomatous Inflammation
        
        Fungi
        
        HIstoplasmosis & Cryptococcus
        
        Protozoal
        
        Toxoplasmosis
        
        Bacteria
        
        TB
      - Storage disorders
        
        Gaucher's Disease
        
        Genetic disorder where there is deposition of glucocerebroside in cells of macrophage-monocyte system
        
        Niiemann Pick disease
        
        Accumulation of lipids in spleen, liver, lungs, bone marrow & brain
        
        Mucopolysaccharidoses
        
        Red pulp expansion by macrophages whose cytoplasm is distended with abnormal storage product
      - Amyloidosis
  - - - Sickle RBC obstruct vessels
      - This causes multiple splenic infarcts
  - - - Treated with emergency splenectomy
      - This leads to massive intraperitoneal haemorrhage which is life threatening
    - - e.g. Infective mononucleosis
  - - - Myeloproliferative disorders
      - Malignant infiltrates
      - Sickle cell anaemia