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Spleen disease and bleeding disorders
Last reviewed: 07.07.2025
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In structure and function, the spleen resembles two different organs. The white pulp, consisting of the periarterial lymphatic membrane and germinal centers, functions as an immune organ. The red pulp, consisting of macrophages and granulocytes lining the vascular space (chords and sinusoids), functions as a phagocytic organ.
The white pulp is the site of production and maturation of B and T cells. B cells in the spleen generate protective humoral antibodies; in certain autoimmune diseases [eg, immune thrombocytopenic purpura (ITP), Coombs-positive immune hemolytic anemias] autoantibodies to circulating blood elements may be synthesized.
The red pulp removes antibody-coated bacteria, old or abnormal red cells, and antibody-coated blood cells (which 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 leukocytes and platelets. During the passage of red cells, the spleen removes included bodies such as Heinz bodies (precipitated insoluble globulin), Howell-Jolly bodies (nuclear fragments), and whole nuclei; thus, after splenectomy or functional hyposplenism, red cells with these inclusions appear in the peripheral circulation. Hematopoiesis usually occurs in the red pulp only during the intrauterine period. After the intrauterine period, hematopoiesis in the spleen can occur when the bone marrow is damaged (eg, by fibrosis or tumor), causing hematopoietic stem cells to enter the circulation and populate the adult spleen.
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