Case Report: Hypersplenism : A Case Report with Postmortem Study

A case of hypersplenism giving rise to a panhematopenia is presented with complete postmortem study. Its association with rheumatoid arthritis permits it to be classified as a Felty’s syndrome. There was histologic evidence to support both of the now existing concepts of the mechanism by which splenic hyperactivity effects its cytopenias. Marked phagocytosis of both red and white cells was noted in the spleen. There was, in addition, similar phagocytic activity throughout the entire R-E system. Equal support for the hypothesis that splenic hyperfunction depresses or blocks bone marrow function was adduced from the finding of a complete maturation arrest of the white cell series of the bone marrow at the myelocytic level.

A third factor, to the best of our knowledge never previously identified in cases of hypersplenism, was also present. This was a circulating substance which produced active lysis of normal white cells and must have contributed to the leukopenia.

The anatomic observations in this case raise the possibility that generalized R-E hyperfunction and not simply splenic hyperfunction may be of significance in the production of cytopenias in some of the patients with so called hypersplenism.