Anwar Ul Haque
Department of Pathology, Pakistan Institute of Medical Sciences, Islamabad.
The spleen is also known as Organ of Galen, a great anatomist of Greek Era and the organ is regarded as “Organ full of mystery” ! Although recognized as one of the important sites of extramedullary hemopoiesis in embryonic and fetal life, it was treated almost as vestigial organ in adult life! With slightest injury to it or its blood supply, spleen was removed and thrown into dust bin! The
pathologists also did not examine spleen meticulously; to them it appeared like a organ composed and comprised of white and red pulps with blood filling the sinusoids and that’s about it. When I was a
first year of resident of pathology in Des Moines, Iowa, USA, two cases one after the other, gave me a shock.1 First was an adult healthy man who had stormy course after a trivial trauma and quickly died despite all aggressive management. He had full blown Waterhouse-Fredricksen syndrome i.e. Disseminated Intravascular Coagulation (DIC) with pneumococcal septicemia and bilateral adrenal hemorrhages. His past history was significant that he had splenectomy after motorbike accident 13 years prior to this episode. Then a few months afterward I saw a woman who presented with pneumococcal septicemia and had lost all her twenty fingers and toes. Fortunately she survived after these rather massive amputations. Her past history was significant because she had had splenectomy due to bicycle trauma 22 years back. These two episodes sensitized me with the importance of spleen and dire life long consequences of missing it.2 We then carried out experiments on Sprague-Dawley rats and found similar findings of Waterhouse Fredricksen Syndrome!3