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Blood Film

Hyposplenism on the Blood Film



  • 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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