Spleen

Question 1

What causes ITP and what is the treatment?

Answer 1

Auto antibodies to GP IIB/IIIA and Ia/IIa

Tx: Steroids, IVIG, splenectomy if refractory

Question 2

When should you give platelets for intraoperative bleed during splenectomy?

Answer 2

After stapling splenic artery

Question 3

Describe the following peripheral blood smears: Howell-Jolly body, Pappenheimer, Target cells, Heinz body, spur cell

Answer 3

Howell Jolly: Nuclear remnant seen in patients post splenectomy

Pappenheimer: Iron deposits

Target cell: Immature RBC

Heinz: Intracellular denatured Hgb

Spur: Deformed membrane

Question 4

What causes hereditary spherocytosis?

Answer 4

Spektrin deficiency; patients need splenectomy if symptomatic by age 6

Question 5

What is pyruvate kinase deficiency?

Answer 5

hemolytic anemia 2/2 impaired glucose metabolism

Question 6

What is angiosarcoma and what is it associated with?

Answer 6

Primary malignant tumor of the spleen; see increased risk with vinyl chloride and thorium dioxide exposure

Question 7

Which six findings are worrisome for malignancy in a lymph node?

Answer 7

1. Increased size
2. Round shape
3. Loss of central fatty hilum
4. Peripheral or mixed vascularity
5. Microcalcifications
6. Ill-defined margins

Question 8

When do you treat a splenic artery aneurysm?

Answer 8

> 2 cm; tx any size in pregnant patients

Tx of choice is endovascular coil embolization

Question 9

What bacteria are you at risk for post splenectomy?

Answer 9

Encapsulated organisms
S. Pneumo
N. meningitidis
H. influenzae

See decrease in optinizations 2/2 to IgM

B thalasemia patients are at highest risk for OPSI

Question 10

What are the symptoms associated with TTP?

Answer 10

Caused 2/2 defective Adam TS- 13 (causes platelet aggregation in microvasculature)

Fever
Anemia
Thrombocytopenia
Renal issues
Neurological isue

(FAT - RN)

Tx: Plasmapheresis