FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

FUNCTIONS OF MISSING SPLEEN DO NOT HAVE TO BE REPLACED WITH SHOTS

Question: One of my friends was in a car accident. His spleen was removed, and now he is taking shots in his stomach. Are the shots to replace the duty of the spleen?

Answer: The spleen is an organ that is located on the left side of the body deep in the abdomen. It serves several important, but not essential, functions. The primary function of the spleen is to remove old blood cells from circulation, and it also serves as part of the body's immune system. It also stores a certain quantity of blood.

Fortunately, because of its location, a minor bump or bruise to the abdomen is unlikely to damage the spleen. The spleen can, however, be damaged in accidents that cause significant trauma to the abdomen. For instance, an unbelted driver in an auto accident can be thrown forward and, thereby, strike his or her abdomen on the steering wheel with a force sufficient to injure the spleen. The rich network of blood vessels in the organ make such an injury to it serious -- perhaps even life threatening. When such injuries cause bleeding in the spleen, it may be necessary -- as it was in your friend's situation -- to remove the damaged organ. This surgery can stop the internal hemorrhage and directly save the individual's life, unless there are complications due to damage to other internal organs and essential structures. However, once the individual recovers from his or her injuries, there is little reason for concern. The absence of a spleen results in no significant additional health concerns.

The reason that a person can do without his or her spleen is that its functions are either not essential or can be taken on by other body organs. In the first category, the task of removing worn out blood cells from circulation is not effectively picked up by other organs, but it's not crucial and doesn't cause any serious health consequence. In the second category, the body's natural built-in redundancy allows a number of other organs to compensate for the spleen's role in warding off infection. Other parts of the immune system -- the thymus, lymph nodes, bone marrow and clusters of other lymphoid cells -- are spread throughout the body and also perform this vital task. These other parts of the immune system can increase their activity enough to nearly compensate for the loss of the spleen.

I don't know what type of medicine your friend is receiving by injection into his "stomach." Shots are not actually given into the stomach, which is that hollow "comma-shaped" organ where your lunch goes, but are instead given into the tissue making up the wall of the abdomen. This is principally muscle and fat. Two drugs are usually given into the abdominal wall, insulin and heparin.

Insulin is used by diabetics to regulate their blood sugar. It is possible that your friend also damaged his pancreas in the auto accident and has consequently become a diabetic. It is more likely, however, that he is using heparin to prevent the formation of blood clots. This treatment may be necessary for a short time after a serious accident like he had. If this is the case, he will have stopped needing these shots long before this column is published.

Instead of worrying about your friend, ask him about his condition and what you can do to help him as he regains his health. I'm sure that he will be pleased that you are interested in his well-being.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.