Disorders of the Feline Spleen
We’ve all heard of
the spleen, but do you really know what it does? And what does a big spleen mean?
Most people can give you a reasonably accurate description
if asked to describe the function of the heart, the kidneys, or the lungs. But
ask about the spleen and you’re met with blank stares, despite the fact that
everyone’s heard of it. Let’s end the
mystery and delve into the world of the feline spleen.
The spleen is a dark red organ located near the stomach. It is longer than it is wide, and has the
appearance of a giant tongue. It is
covered by a capsule made of sturdy fibrous tissue. Blood vessels enter and exit the spleen on
the same side, in an area called the “pedicle”.
The spleen is usually found in the cranial part of the abdomen on the
left side, although the exact location isn’t fixed. Depending on its size and shape, and the size
of the surrounding organs (for example, if the stomach is full), the spleen can
shift position to the right side of the body, or to the caudal part of the
abdomen.
The spleen isn’t essential for life. It can be surgically
removed if necessary, and most animals will be fine. However, the spleen performs important
functions and it’s certainly much better to have one than to not have one.
The spleen has several important functions. It plays a role in “hematopoiesis”, the
production of red blood cells. The bone
marrow is the major site of red blood cell production. The spleen is the next
major site. The spleen is also a storage
site for red blood cells and platelets.
If the body was suddenly in need of additional red blood cells in the
circulation, the spleen has the ability to contract, flooding the bloodstream
with additional blood. Another function
of the spleen is filtration. The spleen
acts as a giant filter that traps and removes old or abnormal blood cells from
the circulation. A fourth function of the
spleen is the trapping and removal of bacteria, foreign proteins, and old cells
through a process called phagocytosis, in which cells of the immune system within
the spleen engulf the offending particles.
A final important function of the spleen is the participation in the
immune response.
Anatomically, the internal structure of the spleen consists
of areas of “red pulp” and areas of “white pulp”, as well as a “marginal zone”
which separates the white and red pulp.
The red pulp contains many sinuses that are engorged with blood, giving
the spleen its characteristic red color. It is in the red pulp that the filtration of
foreign proteins, microorganisms, and defective or old red blood cells
occurs. The white pulp is where the red
blood cells are produced and where the cells of the immune system reside. The marginal zone is the area that separates
the red pulp from the white pulp. Its
primary role is that of blood filtration.
Disorders of the spleen can be generally categorized as
either primary or secondary. In primary
spleen disorders, the spleen itself is the site of the illness. The spleen can also be secondarily affected
by a systemic disease occurring elsewhere in the body. The
most common abnormal finding indicating a problem with the spleen is
splenomegaly – enlargement of the spleen.
This can usually be detected on physical examination, by carefully
feeling the contents of the abdominal cavity during the physical exam.
Enlargement of the spleen occurs in two forms: localized and
generalized. Localized splenomegaly is a
focal enlargement of the spleen, i.e. a splenic mass. Generalized splenomegaly is a diffuse
enlargement of the entire spleen. Localized
splenomegaly is more common in dogs.
Generalized splenomegaly is more common in cats.
Once splenomegaly is detected on physical examination, there
are several diagnostic tests that are helpful in evaluating the cause for the
enlargement. A complete blood count,
serum chemistry panel, urinalysis and abdominal radiographs may provide useful
information. Abdominal ultrasound is an
excellent, non-invasive tool to distinguish whether the enlargement is
localized vs. generalized, and to help further define the underlying disease
process.
In many cases, a definitive diagnosis can only be achieved
by obtaining a sample of the cells from the spleen. This can be accomplished either by aspiration
or by biopsy. Fine-needle aspiration is
a procedure in which a needle, attached to a syringe, is inserted into the spleen. A sample from the spleen is then aspirated
into the hub of the needle and the contents sprayed onto a microscope
slide. The slides are then sent to a
laboratory to be evaluated by a clinical pathologist. Aspiration can be performed under ultrasound
guidance, usually with only mild sedation. This is a safe, reliable method of
evaluating patients with splenomegaly.
If a diagnosis cannot be obtained by the diagnostic tests
described above, exploratory surgery of the abdomen may be required to identify
the underlying disease process. Because
the entire spleen is likely to be affected in cats, rather than obtain a small
piece of the spleen as a biopsy specimen, the entire spleen is removed. The
spleen is then submitted to the laboratory for review by a pathologist. As stated previously, the spleen is an
important organ but it is not necessary for survival, and most animals live
healthy lives following splenectomy.
In cats, unfortunately, infiltration of the spleen with
cancer cells is the most common cause of splenomegaly. The most common cancer is mast cell tumor or
mastocytosis. Lymphoma and
hemangiosarcoma are two other common splenic cancers. In a study published several years ago
evaluating 19 cats who had undergone surgical removal of their enlarged spleen,
10 of the 19 (53%) had mast cell tumor, 4 had hemangiosarcoma (21%) and 2 had
lymphoma (11%). These were the three
most common diseases resulting in splenectomy.
Feline splenic disease is a much rarer entity than its
canine counterpart, but it is still an important condition in veterinary
medicine. The prognosis for cats with splenomegaly
varies depending on the cause.
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