A similar procedure to that for visualizing the spleen, but with undamaged, labelled red cells, provides a relatively simple method for measuring the splenic red cell volume. By quantitative imaging, the fraction of the administered radionuclide present in the spleen is measured 20-30 min after injection. Normally, the spleen contains 5% or less of the red cell volume (about 60 mL), and there is general correlation between splenic red cell volume and the physical size of the spleen. There is a proportionately greater pool in certain disorders; in these, the pool may be a major cause of splenomegaly. Discrepancies between the volume of the spleen and of the red cell pool suggest that the splenomegaly is due, at least in part, to cell or tumour infiltration. The extent of the splenic red cell pool should be taken into account when assessing the significance of anaemia; it also makes it possible to predict the degree to which anaemia will improve following splenectomy.
Splenomegaly is often associated with an increased plasma volume and splenectomy is usually followed by a reduction in plasma volume. This means that in splenomegaly the blood count may give an exaggerated impression of anaemia, so that measurement of red cell and plasma volumes must be included in clarifying the cause of anaemia in conditions associated with splenomegaly.
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