International Journal of Hematology

, Volume 107, Issue 2, pp 157–165 | Cite as

Persistent changes in circulating white blood cell populations after splenectomy

  • Minke A. E. Rab
  • Aafke Meerveld-Eggink
  • Heleen van Velzen-Blad
  • Douwe van Loon
  • Ger T. Rijkers
  • Okke de Weerdt
Original Article


The effect of splenectomy on the incidence of infections and thromboembolisms has been investigated thoroughly. Nevertheless, the long-term effects of splenectomy on immunological profile and circulating blood counts have not been described before. To study such long-term effects, we analysed several parameters in splenectomised trauma patients and compared the results of this group (“otherwise healthy patients”) to patients with a specific underlying disease. We measured platelet count, leukocytes and differential, lymphocyte subsets, serum levels of immunoglobulins, and complement pathways in 113 patients. Indications to perform a splenectomy were trauma (n = 42), Hodgkin lymphoma (n = 24), hereditary spherocytosis (n = 21), and immune thrombocytopenia (n = 26). In trauma patients lymphocytes and lymphocytes subsets were particularly elevated compared to normal population values. Splenectomised patients with Hodgkin lymphoma had significant lower numbers of T lymphocytes than trauma patients. Significant increases in platelets, leukocytes, and monocytes were observed in patients with hereditary spherocytosis. Occurrence of MBL genotype was different in ITP patients than in other splenectomised groups and the normal population. In splenectomised patients (> 4 years), platelet counts and lymphocyte subsets are increased which persist over time. As a result, these blood counts in splenectomised patients differ from reference values in the normal population.


Splenectomy Leukocytes Lymphocyte differential Immunoglobulins Platelet count 



We thank all the patients and laboratory personnel.

Compliance with ethical standards

Conflict of interest

The study was conducted without any financial or commercial relationships. The authors declare there was no conflict of interest.


  1. 1.
    Davies JM, Lewis MPN, Wimperis J, Rafi I, Ladhani S, Bolton-Maggs PHB. Review of guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen: prepared on behalf of the British Committee for Standards in Haematology by a Working Party of the Haemato-Oncology Task Force. Br J Haematol. 2011;155:308–17.CrossRefPubMedGoogle Scholar
  2. 2.
    Toutouzas KG, Velmahos GC, Kaminski A, Chan L, Demetriades D. Leukocytosis after posttraumatic splenectomy. Arch Surg. 2002;137:924–8.CrossRefPubMedGoogle Scholar
  3. 3.
    Weng J, Brown CVR, Rhee P, Salim A, Chan L, Demetriades D, et al. White blood cell and platelet counts can be used to differentiate between infection and the normal response after splenectomy for trauma: prospective validation. J Trauma Inj Infect Crit Care. 2005;117:1076–80.CrossRefGoogle Scholar
  4. 4.
    Banerjee A, Kelly KB, Zhou HY, Dixon SD, Papana Dagiasis A, Quinn LM, et al. Diagnosis of Infection after splenectomy for trauma should be based on lack of platelets rather than white blood cell count. Surg Infect. 2014;15:221–6.CrossRefGoogle Scholar
  5. 5.
    Cameron PU, Jones P, Gorniak M, Dunster K, Paul E, Lewin S, et al. Splenectomy associated changes in IgM memory B cells in an adult spleen registry cohort. PLoS One. 2011;6:e23164.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Meerveld-Eggink A, de Weerdt O, de Voer RM, Berbers GAM, van Velzen-Blad H, Vlaminckx BJ, et al. Impaired antibody response to conjugated meningococcal serogroup C vaccine in asplenic patients. Eur J Clin Microbiol Infect Dis. 2011;30:611–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Meerveld-Eggink A, de Weerdt O, van Velzen-Blad H, Biesma DH, Rijkers GT. Response to conjugate pneumococcal and Haemophilus influenzae type b vaccines in asplenic patients. Vaccine. 2011;29:675–80.CrossRefPubMedGoogle Scholar
  8. 8.
    Meerveld-Eggink A, de Weerdt O, Rijkers GT, van Velzen-Blad H, Biesma DH. Vaccination coverage and awareness of infectious risks in patients with an absent or dysfunctional spleen in the Netherlands. Vaccine. 2008;26:6975–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Comans-Bitter WM, De Groot R, Van den Beemd R, Neijens HJ, Hop WCJ, Groeneveld K, et al. Immunophenotyping of blood lymphocytes in childhood: reference values for lymphocyte subpopulations. J Pediatr. 1997;130:388–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Vlug A, Nieuwenhuys E, van Eijk R, Geertzen H, van Houte A. Nephelometric measurements of human IgG subclasses and their reference ranges. Ann Biol Clin. 1994;52(7–8):561–7.Google Scholar
  11. 11.
    Seelen MW, Roos A, Wieslander J, Mollnes TE, Sjöholm G, Wurzner R, et al. Functional analysis of the classical, alternative, and MBL pathways of the complement system: standardization and validation of a simple ELISA. J Immunol Methods. 2005;296:187–98.CrossRefPubMedGoogle Scholar
  12. 12.
    Endeman H, Herpers BL, De Jong BW, Voorn GP, Grutters JC, Van Velzen-Blad H, et al. Mannose-binding lectin genotypes in susceptibility to community-acquired pneumonia. Chest. 2008;134:1135–40.CrossRefPubMedGoogle Scholar
  13. 13.
    Schoonen MW, Kucera G, Coalson J, Li L, Rutstein M, Mowat F, et al. Epidemiology of immune thrombocytopenic purpura in the general practice research database. Br J Haematol. 2009;145:235–44.CrossRefPubMedGoogle Scholar
  14. 14.
    Blum KS, Pabst R. Lymphocyte numbers and subsets in the human blood. Do they mirror the situation in all organs? Immunol Lett. 2007;108:45–51.CrossRefPubMedGoogle Scholar
  15. 15.
    Bessler H, Bergman M, Salman H, Beilin B, Djaldetti M. The relationship between partial splenectomy and peripheral leukocyte count. J Surg Res. 2004;122:49–53.CrossRefPubMedGoogle Scholar
  16. 16.
    Miko I, Nemeth N, Sajtos E, Brath E, Peto K, Furka A, et al. Splenic function and red blood cell deformability: the beneficial effects of spleen autotransplantation in animal experiments. Clin Hemorheol Microcirc. 2010;45:281–8.PubMedGoogle Scholar
  17. 17.
    Sipka S, Bráth E, Tóth FF, Aleksza M, Kulcsár A, Fábián A, et al. Cellular and serological changes in the peripheral blood of splenectomized and spleen autotransplanted mice. Transpl Immunol. 2006;16:99–104.CrossRefPubMedGoogle Scholar
  18. 18.
    Seabrook TJ, Hein WR, Dudler L, Young AJ. Splenectomy selectively affects the distribution and mobility of the recirculating lymphocyte pool. Blood. 2000;96:1180–3.PubMedGoogle Scholar
  19. 19.
    Chaimoff C, Douer D, Pick IA, Pinkhas J. Serum lmmunoglobulin changes after accidental splenectomy in adults. Am J Surg Surg. 1978;136:332–3.CrossRefGoogle Scholar
  20. 20.
    Order SE. The effects of therapeutic irradiation on lymphocytes and immunity. Cancer. 1977;39:737–43.CrossRefPubMedGoogle Scholar
  21. 21.
    Bjorkholm M, Holm G, Hospital S. Persisting lymphocyte deficiences during remission in Hodgkin’ s disease. Clin Exp Immunol. 1977;28:389–93.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Fuks Z, Strober S, Bobrove AM, Sasazuki T, McMichael A, Kaplan HS. Long term effects of radiation of T and B lymphocytes in peripheral blood of patients with Hodgkin’s disease. J Clin Invest. 1976;58:803–14.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Bjorkholm M, Askergren J, Holm G, Mellstedt H. Long-term influence of splenectomy on immune functions in patients with Hodgkins disease. Scand J Haematol. 1980;24:87–94.CrossRefPubMedGoogle Scholar
  24. 24.
    Mackall CL, Gress RE. Thymic aging and T-cell regeneration. Immunol Rev. 1997;160:91–102.CrossRefPubMedGoogle Scholar
  25. 25.
    Van Den Broek T, Delemarre EM, Janssen WJM, Nievelstein RAJ, Broen JC, Tesselaar K, et al. Neonatal thymectomy reveals differentiation and plasticity within human naive T cells. J Clin Invest. 2016;126:1–11.Google Scholar
  26. 26.
    Troendle SB, Adix L, Crary SE, Buchanan GR. Laboratory markers of thrombosis risk in children with hereditary spherocytosis. Pediatr Blood Cancer. 2007;49:781–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Das A, Bansal D, Ahluwalia J, Das R, Rohit MK, Attri SV, Trehan AMR. Risk factors for thromboembolism and pulmonary artery hypertension following splenectomy in children with hereditary spherocytosis. Pediatr Blood Cancer. 2014;61:29–33.CrossRefPubMedGoogle Scholar
  28. 28.
    Schilling RF, Gangnon RE, Traver MI. Delayed adverse vascular events after splenectomy in hereditary spherocytosis. J Thromb Haemost. 2008;6:1289–95.CrossRefPubMedGoogle Scholar
  29. 29.
    Mayilyan KR. Complement genetics, deficiencies, and disease associations. Protein Cell. 2012;3:487–96.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Tsutsumi A, Takahashi R, Sumida T. Mannose binding lectin: genetics and autoimmune disease. Autoimmun Rev. 2005;4:364–72.CrossRefPubMedGoogle Scholar
  31. 31.
    Pehlivan M, Okan V, Sever T, Balci SO, Yilmaz M, Babacan T. Investiagtion of TNF-alpha, TGF-beta 1, IL-10, IL-6, IFN-gamma, MBL, GPIA, and IL1A gene polymorphisms in patients with idiopathic thrombocytopenic purpura. Platelets. 2011;22:588–95.CrossRefPubMedGoogle Scholar
  32. 32.
    Lammers AJJ, de Porto APNA, Bennink RJ, van Leeuwen EMM, Biemond BJ, Goslings JC, et al. Hyposplenism: comparison of different methods for determining splenic function. Am J Hematol. 2012;87:484–9.CrossRefPubMedGoogle Scholar
  33. 33.
    Marques RG, Lucena SBSG, Caetano CER, De Sousa VO, Portela MC, Petroianu A. Blood clearance of Howell-Jolly bodies in an experimental autogenic splenic implant model. Br J Surg. 2014;101:820–7.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  • Minke A. E. Rab
    • 1
    • 5
  • Aafke Meerveld-Eggink
    • 1
  • Heleen van Velzen-Blad
    • 2
  • Douwe van Loon
    • 3
  • Ger T. Rijkers
    • 2
    • 4
  • Okke de Weerdt
    • 1
  1. 1.Department of Internal MedicineSt. Antonius HospitalNieuwegeinThe Netherlands
  2. 2.Department of Medical Microbiology and ImmunologySt. Antonius HospitalNieuwegeinThe Netherlands
  3. 3.Department of Clinical Chemistry and HaematologySt. Antonius HospitalNieuwegeinThe Netherlands
  4. 4.Department of ScienceUniversity College RooseveltMiddelburgThe Netherlands
  5. 5.Department of Internal Medicine and DermatologyUniversity Medical Centre UtrechtUtrechtThe Netherlands

Personalised recommendations