Hyposplenism on the Blood Film
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:
- Howell-Jolly bodies:
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