Potential role of Howell−Jolly bodies in identifying functional hyposplenism: a prospective single-institute study

Nakagami, Yuya; Uchino, Kaori; Okada, Hiroaki; Suzuki, Kôjiro; Enomoto, Megumi; Mizuno, Shohei; Yamamoto, Hiroaki; Hanamura, Ichiro; Nakayama, Takayuki; Tani, Hiroya; Takami, Akiyoshi

doi:10.1007/s12185-020-02925-7

Cited by 5 publications

(5 citation statements)

References 35 publications

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“…Similarly, splenic thrombosis is infrequent and should be suspected in patients with left-sided abdominal pain [ 17 ]; however, due to indistinct clinical presentation, the incidence of splenic infarcts is often underestimated as abdominal imaging is not routinely performed and they are often incidental findings. However, as also shown in our case, the presence of Howell–Jolly bodies certified the splenic dysfunction, as this type of red blood cell would normally be filtered by a functional spleen [ 18 ]. Importantly, our case demonstrated that the functional asplenia may persist even months after the acute phase of splenic infarct highlighting the need for continuous antibiotic treatment, correct administration of vaccines and vigilance for potential infections.…”

Section: Discussionsupporting

confidence: 61%

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been associated with a high incidence of arterial and venous thrombotic complications. However, thromboembolic events in unusual sites such as limb and visceral arterial ischemia are reported rarely in the literature. Herein, we describe a rare case of a patient with severe coronavirus disease 2019 (COVID-19) infection who experienced severe abdominal pain during the hospitalization and presented simultaneously renal artery, splenic artery and vein as well as aortic thrombi despite prophylactic antithrombotic treatment. Information about his follow-up post discharge is also provided. This case report raises significant clinical implications regarding the correct dose of antithrombotic treatment during the acute phase of the severe COVID-19 infection and highlights the need for incessant vigilance in order to detect thrombosis at unusual sites as a possible diagnosis when severe abdominal pain is present in severe COVID-19 patients.

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Section: Discussionsupporting

confidence: 61%

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

et al. 2022

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“…It is noteworthy that the morphological study also revealed a reduction in the percentage of red pulp in most splenic nodules. According to literature data (9,10), the presence of Howell-Jolly bodies in peripheral blood smears is considered a reliable marker of hyposplenism. Occasional variations in the shape or size of erythrocytes in peripheral blood may be considered normal, but the presence of erythrocytes with inclusions indicates significant changes in the spleen.…”

Section: Discussionmentioning

confidence: 99%

The morphological and functional rationale for the potential compensatory role of disseminated postsplenectomy splenosis in an experiment

Klyuev,

Gorodkov

2023

Preprint

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Aim to investigate disseminated post-splenectomy splenosis (DPSS) by creating an experimental model and analysing the timing, frequency, morphological features, and functional capabilities of splenosis nodules. Materials and methods The experiment involved surgical modelling of DPSS in white laboratory rats and a sham operation group. The rats were euthanized at different time points after the surgery, and the DPSS foci were examined histologically. Functional assessments were conducted by evaluating phagocytic parameters and morphological examination of erythrocytes. Results DPSS foci were observed in the majority of rats (79%) at various time points after the surgery. The foci appeared as dark cherry-coloured round formations of different sizes and were commonly found on the greater omentum, stomach serous membrane, colon serous membrane, and root of the mesentery. Histological examination revealed a cell composition similar to the spleen, including white pulp components and a high number of plasma cells. However, the typical histological architecture of the spleen was not preserved in the DPSS nodules. The phagocytic index and phagocytic number were within normal range in rats with DPSS after 30 days, indicating normal phagocytic activity. However, after splenectomy, these parameters were lower compared to the DPSS group. The opsonic index was significantly below normal levels in the early stages after splenectomy but reached normal values later on. Morphological examination of erythrocytes showed poikilocytic deviations and increased Howell-Jolly bodies, indicating inadequate utilization of degenerative forms of erythrocytes by DPSS nodules. Conclusion The DPSS showed partial functional activity in experiment, including phagocytic capabilities, although the histological architecture of the spleen was not fully preserved. The study provides valuable insights into the characteristics of DPSS nodules and their potential functional role.

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“…The presence of Howell-Jolly bodies (nuclear remnants) is considered an indicator of splenic hypofunction, 10 Flow cytometry for IgM+ Cd27+ B cells Evaluation of a specific subset Easily available blood test [98] may be seen after partial splenic embolisation. 11 Other red cell abnormalities observed in the peripheral blood film in patients with hyposplenism include acanthocytes (spur cells), target cells, haemoglobin precipitates (Heinz bodies) and iron granules (Pappenheimer bodies).…”

Section: Diagnosis Of Hyposplenismmentioning

confidence: 99%

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

Ladhani,

Fernandes,

Garg

et al. 2024

Br J Haematol

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SummaryGuidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non‐infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti‐microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.

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Potential role of Howell−Jolly bodies in identifying functional hyposplenism: a prospective single-institute study

Cited by 5 publications

References 35 publications

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

A COVID-19 Patient with Simultaneous Renal Infarct, Splenic Infarct and Aortic Thrombosis during the Severe Disease

The morphological and functional rationale for the potential compensatory role of disseminated postsplenectomy splenosis in an experiment

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline

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