Splenic imaging in a patient with functional asplenia

Area of Science:

• Nuclear medicine
• Hematology
• Diagnostic imaging

Background:

• Functional asplenia, characterized by absent splenic function without anatomic absence, poses diagnostic challenges.
• Howell-Jolly bodies on peripheral blood smears are indicative of splenic dysfunction.
• Accurate diagnosis of splenic status is crucial for managing infection risk.

Observation:

• A 65-year-old woman presented with neurological deficits and Howell-Jolly bodies on a complete blood count (CBC).
• Initial liver-spleen scan showed no sulfur colloid uptake, suggesting functional asplenia.
• A subsequent Tc-99m heat damaged red blood cell study revealed a spleen of normal size with preserved sequestering function.

Findings:

• The Tc-99m heat damaged red blood cell study successfully identified splenic tissue and function.
• This confirmed functional asplenia, ruling out anatomic asplenia, vascular issues, or congenital anomalies.
• The study highlighted a potential qualitative difference in splenic processing of sulfur colloid versus heat damaged red blood cells.

Implications:

• Tc-99m heat damaged red blood cell scintigraphy is a valuable tool for diagnosing functional asplenia.
• This imaging modality can differentiate functional from anatomic asplenia.
• Understanding differential splenic function is important for patient management and risk assessment.