July 25, 2008 · In the past, scientists discounted the importance of the spleen, a five-ounce organ located in the upper left abdomen. Now, there's an increasing understanding of the spleen's importance as a part of the immune system, filtering blood and removing old blood cells.

Writing this week in the Proceedings of the National Academy of Sciences, a team of investigators reports that the spleen and the brain may be more closely connected than previously thought.

The splenic nerve, the researchers find, can communicate with the vagus nerve, which then serves as a conduit of information from the brain to the immune system. Manipulating the central nervous system may allow medical professionals to stimulate activity within the spleen, producing compounds needed to fight infection.

Scientist Mauricio Rosas-Ballina, one of the researchers on the project, talks with host Ira Flatow about the findings.

Spleen Removal Can Help Hepatitis C Patients with Cirrhosis Tolerate Treatment

By Liz Highleyman

Many individuals with cirrhosis related to chronic hepatitis C have low Model for End-Stage Liver Disease (MELD) scores, which are used to prioritize patients for liver transplantation. While it is too early for such patients to undergo transplants, they may have too advanced thrombocytopenia (low platelet levels) to safely receive interferon.

The spleen is an abdominal organ that removes old blood cells from circulation. Patients with cirrhosis often have an enlarged spleen (splenomegaly) that removes too many thrombocytes (platelets), cells necessary for blood clotting. This can lead to excessive bleeding or bruising. Hepatitis C therapy with interferon plus ribavirin can be dangerous in patients with thrombocytopenia. Removal of the spleen (splenectomy) may be performed to correct this condition.

In the September 2006 Journal of Clinical Gastroenterology, researchers reported on a series of cases in which splenectomy was performed to raise platelet counts so that cirrhotic hepatitis C patients could be treated with pegylated interferon plus ribavirin.

The authors conducted a retrospective chart and computer record review that identified 7 such patients; 4 were men, 3 were women, and the average age was 45 years. All underwent elective splenectomy for thrombocytopenia before starting treatment regimens containing pegylated interferon-alpha 2b (Peg-Intron).

Prior to splenectomy, all had thrombocytopenia contraindicating anti-HCV therapy. Most patients (5) had Child's-Pugh Class A cirrhosis, while 2 had Class B.

Results

All 7 patients experienced increases in their platelet counts by an average of 221 days after spleen removal (mean increase 32,400 to 222,140 cells/mL; P < 0.01).

The median hospital stay was 9 days (range 4-25).

The median amount of blood loss was 750 mL (100 to 2500 mL); patients required varying amounts of replacement platelet packs, units of packed red blood cells, and fresh frozen plasma (ranging from 0-14 units).

There were no deaths or cases of portal vein thrombosis.

1 patient who had already received a liver transplant had significant morbidity.

5 patients were able to complete therapy with pegylated interferon plus ribavirin; 1 was still on therapy at the time of the report, and 1 was awaiting treatment initiation.

Of the 5 who completed therapy:

- 2 achieved sustained virological response;
- 1 was a non-responder;
- 1 experienced HCV breakthrough during therapy;
- 1 experience HCV relapse after completing therapy.

Conclusion

The authors concluded that, "Splenectomy in patients with hepatitis C cirrhosis can be done safely to allow application of antiviral treatment and potentially avoid transplantation."

They added that splenectomy "may be considered in patients with Child's-Pugh A cirrhosis, no prior abdominal surgeries, and with non-1 HCV viral genotype." It was not clear from the report why the procedure would not be expected to also benefit patients with genotype 1 HCV.

9/19/06

Reference
P H Hayashi, C Mehia, H J Reimers, and others. Splenectomy for Thrombocytopenia in Patients With Hepatitis C Cirrhosis. Journal of Clinical Gastroenterology 40(8): 740-744. September 2006.

http://www.hivandhepatitis.com/hep_c/news/2006/091906_c.html

Spleen?
Do we need it?

Spleen Geography 101:
A part of the lymphatic system, the dark purplish spleen lies in the upper left abdomen protected by the lower ribs. (Our unscientific, people-on-the-street survey suggests wide gaps in anatomy knowledge. "Where is the spleen?" was met with, "Uh, it's somewhere in the main part of the body--not in the extremities.")

My, What a Fine Looking Spleen:

Size and weight can vary greatly, but in healthy adults the spleen is often about 5 inches long by 3 inches wide and 1 1/2 inches thick. A typical spleen weighs in at about 6 ounces in a healthy adult. But when it becomes enlarged--from malaria or other diseases--it can weigh a hefty 4 pounds or so.

They're Not Just for Venting:

Not that you've noticed, but the spleen is a busy little part. Its main tasks are to remove worn-out and damaged red blood cells and platelets and to help the body fight off infection.

It filters foreign substances from the blood and produces white blood cells called lymphocytes, which help boost immunity.

Whose Spleen Is It, Anyway?:

Spleens are handled by internists, though hematologists (physicians specializing in blood and blood-producing organs) and oncologists (physicians specializing in tumors) also provide spleen care, depending on the exact problem.

Spleens Gone Bad:

So what can go wrong with the spleen? It can get too big, sometimes producing a soreness. Besides malaria, a host of other disorders are accompanied by enlargement of the spleen. A partial list:

infectious mononucleosis, chronic liver problems, rheumatoid arthritis, lupus, the early stages of AIDS. In sickle cell anemia patients, the spleen enlarges and then patients lose spleen function, says Dr. Andrew Saxon, professor of medicine and chief of the division of clinical immunology at UCLA.

Patients with Gaucher's disease (a disorder of fat metabolism) have enlarged spleens, as do people with lymphomas and people with idiopathic thrombocytopenic purpura (ITP), a systemic illness marked by low platelet counts, weakness and anemia.

The spleen can also get ruptured in car accidents, falls or stabbings.

If the spleen is injured seriously, or otherwise causes too much trouble, it's likely to get yanked, although in some instances it is repaired.

Spleenless Wonders:

Yes, you can live a full life without your spleen.

About 1% of the population is spleenless, estimates Dr. Lawrence May, an internist at Encino-Tarzana Medical Center.

Among the spleenless is talk show host Jay Leno. In his book "Leading With My Chin" (HarperCollins, 1996), he describes his childhood trip down the banister that ended at the hospital, where he and his spleen parted company.

Spleen Understudies:

The spleen's tasks are largely taken over by other parts of the lymphatic system and the liver. Oddly, some people--no one's quite sure how many--have a spare spleen. An accessory spleen, as it's known, is not rare, Saxon says.

Spleened Versus Spleenless:

"On paper, spleenless is not as good as someone who has a spleen," Saxon says, referring to overall health. "They are more susceptible to infection," he says. Those who have lost a spleen to rupture are generally healthier than those who are spleenless due to lymphoma, for instance, Saxon notes.

Folks without a spleen should take some precautions, experts concur.

Among them:

Get vaccinated against pneumonia and always alert a new doctor or dentist to your condition. When fever strikes, people without a spleen can get sicker quicker, May says.

And dentists may want to take extra precautions to minimize infection risks, says Dr. Eric Sung, a dentist and program director of the UCLA hospital dentistry program.

People without spleens might also want to note that fact on a medical information bracelet

http://www.hepatitis-central.com/hcv/whatis/spleen.html