Occasionally a patient with ITP or hereditary anemia may fail to respond as expected following splenectomy or relapse after an initial response. One possible explanation is a failure to remove all of the patient's functional splenic tissue.
Sources of residual splenic tissue:
(1) accessory spleen (splenunculus)
(2) splenosis (autotransplantation of splenic tissue fragments following splenic rupture)
(3) duplicate spleen
Pattern of Response
Presumption
failure to respond as expected
significant amount of residual splenic tissue present
initial response followed by relapse
small amount that becomes hypertrophied with time
The most useful method for detecting residual splenic tissue is an imaging scan (technicium 99 colloid, chromium-51 labeled erythrocytes, CT, MRI). Evaluation should include the thorax, retroperitoneum and pelvis.
The presence of Howell- Jolly bodies in the peripheral blood smear indicates a lack of splenic function and is evidence against residual splenic tissue causing the relapse.
Proof of residual splenic function is a positive clinical response following removal of residual splenic tissue.
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