Hyposplenism on the Blood Film
February 15th, 2021
Overview
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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