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THE SPLEEN

  • The white pulp (lymphoid tissue) functions in antigen processing and antibody production.

  • The red pulp (monocyte-macrophage system) serves as a filter, retaining defective blood cells and foreign particles.

HYPERSPLENISM (INCREASED SPLENIC FUNCTION)

  • Hypersplenism is considered “appropriate” if it is an exaggeration of normal function, as in hereditary spherocytosis or idiopathic thrombocytopenic purpura, or “inappropriate” if the hyperfunction is a result of vascular congestion or infiltrative disease.

  • It is usually associated with splenomegaly.

  • It causes cytopenias with associated compensatory bone marrow hyperplasia.

  • It usually is corrected by splenectomy, if indicated.

  • Table 26–1 lists the causes of hypersplenism. Table 26–2 lists the causes of massive splenomegaly.

TABLE 26−1CLASSIFICATION AND THE MOST COMMON CAUSES OF SPLENOMEGALY AND HYPERSPLENISM

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TABLE 26−2 CAUSES OF MASSIVE SPLENOMEGALY
  1. Myeloproliferative neoplasms

    1. Primary myelofibrosis

    2. Chronic myeloid leukemia

  2. Lymphomas

    1. Hairy cell leukemia

    2. Chronic lymphocytic leukemia (especially prolymphocytic variant)

  3. Infectious

    1. Malaria

    2. Leishmaniasis (kala azar)

  4. Extramedullary hematopoiesis

    1. Thalassemia major

  5. Infiltrative: Gaucher ...

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