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:
  •