By structure and function, the spleen is essentially 2 organs: the white pulp, consisting of periarterial lymphatic sheaths and germinal centers, acts as an immune organ;the red pulp, consisting of macrophages and granulocytes lining vascular spaces (the cords and sinusoids), acts as a phagocytic organ.
The white pulp is a site of production and maturation of B cells and T cells. B cells in the spleen generate protective humoral antibodies; in certain autoimmune disorders (eg, immune thrombocytopenia [ITP], Coombs-positive immune hemolytic anemias), inappropriate autoantibodies to circulating blood elements also may be synthesized.
The red pulp removes antibody-coated bacteria, senescent or defective red blood cells (RBCs), and antibody-coated blood cells (as may occur in immune cytopenias such as ITP, Coombs-positive hemolytic anemias, and some neutropenias). The red pulp also serves as a reservoir for blood elements, especially white blood cells (WBCs) and platelets.
In some animals, the spleen can contract at times of severe anemia and quot;autotransfusequot; red cells; whether this quot;autotransfusionquot; occurs in humans is unclear. During its culling and pitting of RBCs, the spleen removes inclusion bodies, such as Heinz bodies (precipitates of insoluble globin), Howell-Jolly bodies (nuclear remnants), whole nuclei, and malformed RBCs; thus, after splenectomy or in the functionally hyposplenic state, RBCs with these inclusions and acanthocytes (a type of malformed RBC) appear in the peripheral circulation. Extramedullary hematopoiesis may occur if injury to bone marrow (eg, by fibrosis or tumor metastases) allows hematopoietic stem cells to circulate and repopulate the adult spleen (see also Primary Myelofibrosis and Myelodysplastic Syndrome).
