Hyposplenism: a comprehensive review. Part I: basic concepts and causes

Hyposplenism is not a rare condition and can complicate a remarkable number of illnesses. The two most time-honored diseases associated with the development of hyposplenism are sickle cell anemia and celiac disease. Hyposplenism is relatively easy to recognize by typical changes observed on the peripheral blood smear; including Howell-Jolly bodies, monocytosis, lymphocytosis, and increased platelet counts. Diagnosis can be confirmed by pitted RBC counts or 99Tc-labelled radiocolloid scan of the spleen; wherever available. Diagnosis needs to be made promptly to institute pneumococcal vaccination in a timely fashion and to recognize and treat bacterial infections promptly and aggressively because of the tendency of hyposplenic subject to develop fatal invasive disease. Overwhelming pneumococcal sepsis accounts for the major mortality cases in hyposplenic subjects; however severe infections with other encapsulated bacteria and protozoa have been reported. Hyposplenic individuals may also be at a higher risk for vascular, autoimmune and thrombotic diseases and they may have a higher risk of developing solid tumors. The commonly used pneumococcal polysaccharide vaccine is ineffective in asplenic subjects, because it requires the presence of IgM memory B cells, and should be given before splenectomy. In splenectomized, and functionally hyposplenic subjects, the pneumococcal conjugate vaccine is more effective, because it utilizes a T cell dependent mechanism, and should be the preferred vaccine in these circumstances.