Effect of Splenectomy on Red Cell Production

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Abstract
Splenectomy in 7 patients with hypersplenic anemia was followed by an abrupt decrease in reticulocyte counts and plasma Fe turnover. This decrease took place even when the hemoglobin concentration and the red cell mass were kept constant. Infusion of heated, non-viable red cells did not restore the rate of red cell production to pre-splenectomy values, suggesting that the decrease was not caused by cessation of red cell destruction. Serum erythropoietin levels were unchanged before and after splenectomy, but the serum Fe concentrations dropped to hypoferremic levels after splenectomy despite adequate tissue Fe stores. In view of this hypoferremia it appears possible that the post-splenectomy reduction in erythroid activity is caused by a lack of readily available Fe. Since the hypersplenic spleen was responsible both for the destruction of red cell and for the reutilization of Fe from these cells, it seemed likely that the hypoferremia was caused by the removal of an organ containing readily available Fe. However, a comparable surgical trauma such as elective cholycystectomy was also followed by a hypoferremia, and it appears that the post-splenectomy hypoferremia is caused primarily by an inability to reutilize Fe, similar to the defect in Fe reutilization responsible for anemia of chronic disease.