A lady recently came to the clinic concerned about weight loss and how she felt so full after eating just a little bit. She also indicated that she was having slight constipation problems but perhaps felt that this was due to her eating less. She did not have a fever. On physical examination of her abdomen, it was found there was a large lump on the left side in the upper part of the abdomen. This lump was somewhat firm but not really hard like a cancer. It felt like a normal organ only it was located where there should be no abnormality felt. Her blood count was checked and it was found that she had "too much blood". Further evaluation led to the diagnosis of a condition called polycythemia vera which is a form of leukemia of the red blood cells. This basically means that something had gone wrong with her red blood cell making system and she was making way too many red blood cells even though she did not need them. This condition is effectively treated by the age-old process of removing blood from her system (bleeding) periodically to keep her blood count in the normal range. That will not correct the large lump in her left upper abdomen and she wanted that out of there. She wanted to know what the spleen was and why she needed it if it was getting in her way when she tried to eat. The basic problem was that the spleen is right next to the stomach, and if the spleen gets big, the stomach gets pushed out of the way and cannot fill up as much as it would before.

    Hoffsten's First Law ("Nothing is ever easy") and Hoffsten's Second Law ("Nothing is ever simple") immediately reared their ugly heads. This lady had heard about someone who had once had an automobile accident and ruptured their spleen and had it removed. That lady seemed to be doing fine without a spleen and my patient wanted to know why she needed to keep hers when it was too big and in the way. She had read on the internet that it was not an essential organ and she wanted it out.

    The spleen is basically a filter that removes debris from the blood. Every time you brush your teeth, a few bacteria get into the blood stream. These are filtered out by the spleen and destroyed so they do not cause an infection. Everyday, 1 % to 2% of your red blood cells reach end of life or are damaged through local trauma. These worn out or torn up red blood cells need to be removed from the bloodstream. The spleen performs this purpose also. The spleen is thus a filter to remove foreign material from the blood stream and keep your blood pure. If it is removed for whatever reason, the liver will take over some portion of this filtering process but the body's capacity to deal with a significant infection is compromised. A serious systemic bacterial infection can be fatal in a person without a spleen in just 24 to 36 hours unless intensive antibiotic therapy is started early. Thus, the spleen does have a useful purpose in a crisis.

    Granted that most people do not live in a crisis. My patient said that she was aware that if she got a fever she could get an antibiotic. She wanted her spleen out. I then explained to her that in her particular situation, removal of her spleen would be fatal. That is because, her spleen had taken over the function of making red blood cells. Normally, red blood cells are made in the bone marrow and the spleen acts only as a filter. The organs in our body were designed by the maker to serve multiple functions. If the bone marrow fails for whatever reason, the spleen will take over the job of making blood. In this lady's particular case, removal of her spleen would result in the loss of her ability to make blood. With apologies, I told her that it was essential that she keep her spleen and put up with the lump in her left upper abdomen. She was instructed to eat small amounts frequently in order to maintain her weight.

    There are a number of situations where removal of the spleen is important. One of these is in a condition called hereditary spherocytosis in which the person makes an abnormal shaped red blood cell. In fact, this red blood cell works just fine but the spleen does not know that. It looks upon these abnormally shaped red blood cells as foreign and in need of removal. Thus, the person's spleen eats their own red blood cells and causes an anemia. Removal of this person's spleen then becomes curative for their anemia. There is another condition called idiopathic thrombocytopenic purpura (Wow! What a name) or ITP for short. In this condition, the person becomes allergic to their own platelets. Platelets are normal particles in the blood and they promote clots in cuts that occur. As their own platelets are damaged by the allergic reaction, the spleen removes them very quickly and the person can have major bleeding problems. Usually, ITP is treated with cortisone but in some cases this is not enough and the spleen has to be removed in order to keep the person from hemorrhaging.

    Lastly, it needs to be understood that the spleen is a very delicate organ with a thin capsule around it. When this capsule is ruptured through automobile accidents or athletic injuries, hemorrhage can be severe as in the case of the famous model, Nicole Taylor, who was recently injured in an automobile accident in Atlanta. The condition is often difficult to diagnose; however, when it is diagnosed, the spleen has to be removed because trying to sew it back together is like trying to sew tissue paper and it simply does not work.

So the answer to the question of, "What is the spleen?" is:

1. The spleen is a filter that removes particles from the blood. It is an important protector to prevent overwhelming infections.

2. When needed, the spleen is an accessory blood factory to takeover the job of the bone marrow when the bone marrow fails. Then it becomes an essential organ as in the lady with polycythemia vera.