Oh, My Spleen!

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A long-time reader wrote in asking about “the forgotten organ: the spleen.” Maybe he was motivated by the common references found on social media about this elusive organ or the lack of telethons in its support.

Forgotten by some, the spleen is in the forefront of a trauma surgeon’s mind when a patient arrives at the emergency department following blunt or penetrating trauma to the chest or abdomen. They may have been in a car accident or had a sports injury, for example.

The spleen is generally well protected in the left upper quadrant of the abdomen, behind the lower ribs. It is highly vascular and vulnerable to injury in the right circumstances and is one of the abdominal organs with a high incidence of injury and hemorrhage.

You may wonder, “If it is so prone to bleeding, why do we have a spleen in the first place and what is the role of this fist sized organ?”

The spleen is a major player of the lymphatic system and so has an important role in the body’s immune system. It produces and stores white blood cells (WBC) and antibodies needed to fight infection. They lay in wait and mobilize into the blood stream when needed.

It also makes red blood cells (RBC), and platelets (PLT) for clotting. The spleen houses up to 30 percent of our body’s RBCs and up to 25 percent of our PLTs. It acts as a filter to remove old or damaged RBCs. The spleen also recycles iron and other components from those cells and uses them to make new ones. Finally, it identifies circulating pathogens (bacteria, viruses, fungi, or parasites) and marks them for destruction. The specialized WBCs, or splenic macrophages, destroy these harmful pathogens.

Although we can survive without a spleen, a person’s risk of infection will be higher. The spleen can filter out certain encapsulated bacteria that can sneak by the body’s other defenses. Fortunately, we have vaccines against these common encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenza, and Neisseria meningitidis). If you have had a splenectomy, infections without up-to-date vaccinations can lead to serious infections if not quickly addressed

Perhaps the spleen gets no respect and is the brunt of jokes, as its responsibilities can be taken over by the bone marrow, the liver, and lymph nodes. As more research is done and greater knowledge obtained about the importance of this “forgotten” organ, conceivably, unlike Rodney Dangerfield, the spleen will get the respect it deserves.

Dr. Madayag is a general surgeon at Lutheran Medical Center.

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