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Blood Film

Hyposplenism on the Blood Film

February 15th, 2021


Certain characteristic findings on a blood film are suggestive of hyposplenism or asplenism. This may be congenital, iatrogenic (particularly post splenectomy) or associated with acquired medical conditions.
Patients with hyposplenism are at increased risk of infections - particularly with encapsulated bacteria (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae).
  • Blood Film Findings in Hyposplenism

  • Red Cell Findings

  • Target cells
  • Acanthocytes
  • Howell-Jolly bodies
  • Pappenheimer bodies
  • White Cell Findings

  • Neutrophilia (initially)
  • Lymphocytosis
  • Monocytosis
  • Platelet Findings

  • Thrombocytosis
  • Causes of Hyposplenism

  • Congenital

  • Prematurity
  • Congenital hyposplenism
  • Iatrogenic

  • Post splenectomy
  • High dose steroids
  • Bone marrow transplant
  • Acquired Conditions

  • Vascular - splenic artery / vein thrombosis
  • Haematologic - sickle cell disease, leukaemia, graft vs host disease
  • Gastrointestinal - coeliac disease, inflammatory bowel disease, Whipple's disease
  • Hepatic - liver cirrhosis, portal hypertension, active chronic hepatitis
  • Autoimmune - SLE, Sjogren's syndrome rheumatoid arthritis, polyarteritis nodosa
  • Infiltrative - amyloidosis, sarcoidosis
  • Infection - HIV/AIDS
  • Examples

  • Target cells:
  • Target cells
  • Howell-Jolly bodies:
  • Howell-Jolly bodies
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