Leucocyte changes

After splenectomy, there is a rise in the total leucocyte count. A neutrophil leucocytosis in the immediate postoperative period is, in the majority of subjects, later replaced by a significant and permanent increase in both lymphocytes and monocytes. After a few weeks, the neutrophil count returns to normal or near normal

Table 21.2 Causes of hyposplenism.

Congenital aplasia syndrome Ageing

Haematological disorder Sickle cell disease Thrombocythaemia Myelofibrosis Malaria Lymphomas Circulatory

Splenic arterial/venous thrombosis Autoimmune disease

Systemic lupus erythematosus Rheumatoid arthritis Hyperthroidism Sarcoidosis

Chronic graft-versus-host disease Combined immunodeficiency Gastrointestinal (? immune basis) Gluten-induced enteropathy Dermatitis herpetiformis Crohn's disease Ulcerative colitis Tropical sprue Infiltrations Lymphomas S├ęzary syndrome Myelomatosis Amyloidosis

Secondary carcinomas, especially breast Cysts, e.g. hydatid Nephrotic syndrome Drugs

Methyldopa

Intravenous gammaglobulin Corticosteroids Irradiation

Splenectomy and splenic embolization levels. Minor increases in blood eosinophils and basophils have been noted after splenectomy but this is not a regular feature.

In response to infection, splenectomized subjects produce a much greater leucocytosis than persons with intact spleens. Often there is a marked left shift in the differential leucocyte count, with myelocytes and occasionally more primitive cells.

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