Detection and functional assessment of accessory splenic tissue (splenunculi) with radiolabelled heat damaged autologous erythrocytes.

Eight patients (six with idiopathic thrombocytopenic purpura, one with immune pancytopenia, and one with autoimmune haemolytic anaemia), who had previously been splenectomized, were found to have splenunculi using radioactively labelled heat damaged autologous erythrocytes. In all patients the splenunculi were found to have significant 'splenic function'. However, there was a poor correlation between the size and the function of the splenunculi. Splenunculectomies were carried out in two patients. This led to a complete haematological remission in one patient and partial remission in the other. In three patients, where splenunculectomies could not be undertaken, the patients had to remain on significant doses of immunosuppressive therapy. In one patient complete remission was achieved using a course of immunosuppressive therapy alone and in the remaining two there was insufficient information to draw valid conclusions. Blood clearance kinetic studies of heat damaged erythrocytes were found to provide an accurate functional assessment of the splenunculi in all patients. However, the presence of a functional splenunculus was found to be the cause of disease relapse in only some patients. Therefore, the management of similar patients should perhaps be along the same lines as that at their initial presentation, that is, immunosuppressive therapy should be tried if they are not on any at the time of relapse, if they are already on it, then splenunculectomy should be done.