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BODY ADJUSTS TO SPLEEN LOSS

Q. My daughter recently lost her spleen after an automobile accident. Could you provide some information on the spleen and the lack thereof?

- M.M.

A. The spleen is a spongy, fist-sized organ located in the upper left area of the abdomen, behind the stomach.

As your daughter found out, this location makes the spleen vulnerable to rupture after a severe blow to the stomach area. A ruptured spleen is the most common serious complication of abdominal injury, such as from auto accidents, athletic mishaps and beatings.

The spleen can be damaged by other factors than traumatic injury, including thrombocytopenia (decreased blood platelets), tumors, anemia and other blood-related and systemic diseases.

The spleen produces, monitors and destroys blood cells. The spleen can also act as a reservoir of blood, providing expanded blood volume when needed.

The spleen consists of non-compartmentalized spongy tissue surrounded by a thin but relatively tough fibrous lining. The spongy tissue is composed of red pulp (80 percent) and white pulp (20 percent).

The red pulp contains red blood cells, and its function is to repair or destroy damaged or defective red cells. The red pulp also contains white cells known as phagocytes that ingest unwanted material such as bacteria or defective cells.

The white pulp contains lymphocytes and macrophages, and is an integral part of the immune (infection-fighting) system.

When the spleen is ruptured, blood can flow out into the abdominal cavity. If this leakage is severe, surgery to remove the spleen (splenectomy) and to tie off the splenic blood vessels is needed immediately to prevent life-threatening blood loss.

Usually the complete spleen is removed, but when the rupture is not severe, the area can be closed off and part of the spleen can be saved. The most common complication of a splenectomy is internal bleeding.

As you would expect, people who undergo a splenectomy are at increased risk of developing a systemic infection associated with the surgery. That is why precautionary antibiotics and vaccines are given before and after the surgery.

For some time after a splenectomy, the body loses some of its ability to fight off infection - to produce antibodies and to remove unwanted infectious agents. During this time, prophylactic antibiotics may be recommended.

Fortunately, after a short time other organs increase their infection-fighting capability to pick up the slack. So this increased risk of infection usually lasts only a little while.

Update on STDs: Because of the increased - and all too often indiscriminate - use of antibiotics, more and more infections are becoming resistant or even untreatable with commonly used antibiotics.

This is unfortunate for all types of infections, but even more so with sexually transmitted diseases. So a recent report from the Centers for Disease Control identifying new outbreaks of resistance in Hawaii and Missouri (the latest examples) is particularly disheartening.

Many people find it difficult to seek medical help for an infection involving sexual organs. Whether it's due to embarrassment or fear, too many STDs get bad treatment in the first place.

And when the prescribed treatment doesn't work, it's all the worse. They are unaware of treatment failure because symptoms are suppressed for a while and the person avoids a return medical visit for lab tests to be sure.

As the name STD implies, it can be transmitted to others. So even well-meaning people are passing on the disease when they believe they are not infected.

The moral of this story is, if people are sexually active, they need to take the responsibility to protect themselves and others by learning about STDs, seeking help as soon as they are suspicious of an infection, and getting follow-up care to make sure the infection is cured.

Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1500, Chicago, Ill., 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.

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