‘Splaining the Spleen

Typical responses when the calls went out to experts to discuss today’s Body Works part:

“The spleen?”

“You’re sure you want to talk about this?”

“There are more interesting parts to talk about.”

Eventually, though, the spleen docs warmed up to the idea, ultimately demonstrating enough savvy to claim impressive cash prizes should Alex Trebek ever offer spleens-for-a-hundred.

Spleen Geography 101: A part of the lymphatic system, the dark purplish spleen lies in the upper left abdomen protected by the lower ribs. (Our unscientific, people-on-the-street survey suggests wide gaps in anatomy knowledge. “Where is the spleen?” was met with, “Uh, it’s somewhere in the main part of the body--not in the extremities.”)

My, What a Fine Looking Spleen: Size and weight can vary greatly, but in healthy adults the spleen is often about 5 inches long by 3 inches wide and 1 1/2 inches thick. A typical spleen weighs in at about 6 ounces in a healthy adult. But when it becomes enlarged--from malaria or other diseases--it can weigh a hefty 4 pounds or so.

They’re Not Just for Venting: Not that you’ve noticed, but the spleen is a busy little part. Its main tasks are to remove worn-out and damaged red blood cells and platelets and to help the body fight off infection. It filters foreign substances from the blood and produces white blood cells called lymphocytes, which help boost immunity.

Whose Spleen Is It, Anyway?: Spleens are handled by internists, though hematologists (physicians specializing in blood and blood-producing organs) and oncologists (physicians specializing in tumors) also provide spleen care, depending on the exact problem.

Spleens Gone Bad: So what can go wrong with the spleen? It can get too big, sometimes producing a soreness. Besides malaria, a host of other disorders are accompanied by enlargement of the spleen. A partial list: infectious mononucleosis, chronic liver problems, rheumatoid arthritis, lupus, the early stages of AIDS. In sickle cell anemia patients, the spleen enlarges and then patients lose spleen function, says Dr. Andrew Saxon, professor of medicine and chief of the division of clinical immunology at UCLA.

Patients with Gaucher’s disease (a disorder of fat metabolism) have enlarged spleens, as do people with lymphomas and people with idiopathic thrombocytopenic purpura (ITP), a systemic illness marked by low platelet counts, weakness and anemia.

The spleen can also get ruptured in car accidents, falls or stabbings.

If the spleen is injured seriously, or otherwise causes too much trouble, it’s likely to get yanked, although in some instances it is repaired.

Spleenless Wonders: Yes, you can live a full life without your spleen. About 1% of the population is spleenless, estimates Dr. Lawrence May, an internist at Encino-Tarzana Medical Center.

Among the spleenless is talk show host Jay Leno. In his book “Leading With My Chin” (HarperCollins, 1996), he describes his childhood trip down the banister that ended at the hospital, where he and his spleen parted company.

Spleen Understudies: The spleen’s tasks are largely taken over by other parts of the lymphatic system and the liver. Oddly, some people--no one’s quite sure how many--have a spare spleen. An accessory spleen, as it’s known, is not rare, Saxon says.

Spleened Versus Spleenless: “On paper, spleenless is not as good as someone who has a spleen,” Saxon says, referring to overall health. “They are more susceptible to infection,” he says. Those who have lost a spleen to rupture are generally healthier than those who are spleenless due to lymphoma, for instance, Saxon notes.

Folks without a spleen should take some precautions, experts concur. Among them: Get vaccinated against pneumonia and always alert a new doctor or dentist to your condition. When fever strikes, people without a spleen can get sicker quicker, May says.

And dentists may want to take extra precautions to minimize infection risks, says Dr. Eric Sung, a dentist and program director of the UCLA hospital dentistry program.

People without spleens might also want to note that fact on a medical information bracelet.