The untold stories by spleen,If spleen could ever speak
Hello,I am spleen,For people who don’t know me I stay in the corner of the street left hypochondriac ,beside the gurgling stomach’s house.As you come down from the liver junction into the portal vein road,take left on to the splenic vein road ,I stay at the dead end.Before you come to meet me make sure you are not a blood cell because I may eat you.Actually all the other organs think that I am bad person because I eat up cells,but they all will never realise that I eat only the old cells which are not of much use,and I am a big fan of Euthanasia.All these people see me as a villain and they even named the ugly ,huge, foul smelling colonic turn by my name as splenic flexure.I don’t understand what mistake I have done.
And sometimes when these people surrounding me irritate me in one or the other way I enlarge,And later they in-turn blame me for eating all the cells when I enlarge. I get irritated ,disturbed by these people around me in different ways .I can give you examples where I got enlarged in patients who presented at Kamineni Narketpally.
https://healthjade.net/portal-vein/
The first patient was a 20 year old female who studied upto 8th class and happily married .I have been observing her since the past 1 year,her liver is making her eyes turn lemon yellow,she is having SOB on exertion since 1 year and also I have heard from the left kidney ,who is one of my neighbours,that the uterus which stays in the basement is not working well and troubling her with irregular menses since the past 1 year.She almost lost 10kgs from the last one year,and I felt the ribs coming closer to me,I haven’t seen Mr.Fat these days.Mr.Muscle is also becoming thinner.I noticed that the number of blood cells coming to me have decreased.I think Mrs.Bone marrow is not cooking the blood cells well these days.I thought May be I should help her .I slowly enlarged and I started cooking the blood cells,which I have learnt in my childhood during extra-medullary hematopoiesis classes.I asked my friend liver also do the same.She took all of us to Kamineni hospital where the doctors have taken our history and have done a brief examination,I heard them discussing that she has pallor,parasternal heave,solitary thyroid nodule.This is the time during examination when I usually get hurt the most,because all the doctors one by one come and they start palpating me,infact they started compressing me,pulling me from behind hooking their finger near my tail and that was so painful and discomfortable for me.They started to get excited saying spleen…spleen…. as if I was something abnormal.They have hurt me both physically and emotionally,but I stayed calm because I know they would help us ultimately.I heard doctors discussing that her Hb was 6.7g/dl,TLC 4,400cells/Cumm,MCV 63.0,MCh 20.4,PCV 20.6,platelets 2.07lakhs,PBS showing microcytic hypochromic,Retic count 0.5%,Absolute retic count 0.2%,RPI 0.1% ,Coombs test negative.They even measured me using USG ,I was proudly 15cms.As I expected ,there was something wrong with Mrs.Bone marrow as the tests were suggestive of hypo proliferate marrow.But generally Mrs.marrow is a good person,She cooked me cells all these days,I wanted to complain the doctors that I was suspicious about iron,but one of the doctors already came with the ferritin report saying it was 6. There it is,it’s all that stupid iron’s fault who comes and goes whenever he wants to come.I thought they would give her iron and send home.But one of the doctors pointed out that she has something in her called gamma gap(difference between total protein and serum albumin is 4.8 ),it could be polyclonal or monoclonal,Her TFT showing T3:2.89,T4 :17.65,TSH 0.07,was started on tab carbimazole 5mg TId,she has also complained about Tingling sensations in her limbs, as it is so long journey for me to go to the leg nerves I left it for the doctors to sort it out.Serum Vit B12 levels came normal,that doctor also noticed that her legs to be a little hyperpigmented compared to rest of the body.He suspected it to be POEMS (polyneuropathy-sensory symptoms,organomegaly-hepatosplenomegaly,endocrinopathy-thyroid,myeloma-gamma gap,skin changes),they have mistaken her plasma cells for malignancy and they thought that I was having a illegal relation with plasma cells and I got infiltrated by plasma cells and amyloid.Please Don’t judge a book by its cover,I tried to help her and these people blame me now.I wanted to prove that everything was irons fault and I had nothing to do with plasma cells.She was adviced to get serum electrophoresis done but she dint have any money.They went ahead with bone marrow biopsy which proved my genuinity as it showed erythroid hyperplasia with micronormoblastic maturation ,myelosuppression with mild reactive plasmacytosis.This finally proved that I dint have anything to do with plasma cells and I was just helping her.It’s all iron’s fault.
Case report link:https://chandanavishwanatham1909.blogspot.com/2023/01/case-1.html
Similar thing happened with 2 other patients
one patient was 23 year male occasional alcoholic took us to the doctor with complaints of yellowish discolouration of eyes,SOb on exertion,Abdominal discomfort since 1week,1 episode blood in stools with pallor on examination,knuckle hyperpigmentation,icterus,flow murmur.All the blood cells and bone marrow waited for years together for vitamin b12, but he never came.3 years ago he was infused with alien cells (prbc) as he had anemia and was told to be due to b12 deficiency.Even though ,he did not care to eat non veg,dairy products .Those alien cells were good to me so I allowed them to stay for a while in the body, and I tried helping the boy with extra medullary hematopoiesis .This time I was just 12.5cms borderline enlarged,LFT,RFT was normal except slightly raised TB 2.68.His Hb was 2.1,TLC 3100,platelets 37000,MCV 106.9,MCH 36.2,RBC 0.58,Retic count 0.6,corrected Retic 0.1 suggesting hypoproliferative marrow but this time serum ferritin was 156,Serum B12 also came normal (410pg/ml),serum folic acid 9.24(normal).I was wondering whose fault it is then?.The doctors boss has told them that these tests have very low sensitivity and specificity.So they again went ahead with that painful bone marrow.Bone marrow biopsy was reported as DUAL deficiency anemia with mild dyserythropoiesis(as there was erythroid hyperplasia with micronormoblastic and megalobalstic changes).That is when I came to know that ultimately they is nothing superior to histopathology.He was given b12,iron and folic acid supplements.
Case report link:
https://chandanavishwanatham1909.blogspot.com/2023/01/case-2-spleenomegaly.html
Other patient was 20 years old male patient who had neck pain ,back pain since 2 days and fever since 1day.Jaundice 10 days back which subsided.We we’re given those alien blood cells at the age of 12 years .There was pallor on examination.I thought ,as in previous patients if I get mildly enlarged there will be no use ,let be become massive to 19.8cms and see.His Hb was 6,TLC 2500,platelets 1.54,MCV,MCH,MChC:,PBS microcytic hypochromic anemia and leukopenia .RFT normal,Slightly raised Tb 2.51,Coombs negative.His ferritin was 5.1.Atleast this time I thought they will send us home without that painful bone marrow test with iron supplements.But everyone looking at me being massively enlarged,They suspected it to be some kind of haemoglobinopathy or malignancy and they went ahead with bone marrow again.It’s all my fault ,I shouldn’t have enlarged so much.Mrs.Bone marrow was angry with me.How many times should I prove them that I was just trying to help the patient.The bone marrow again turned out to be DUAL deficiency anemia with erythroid hyperplasia (both micronormoblastic and megaloblastic maturation).
Case report link: https://chandanavishwanatham1909.blogspot.com/2023/01/case-3-splenomegaly.html
The previous patient had dual deficiency but predominantly B12,and this patient also has dual deficiency but predominantly iron deficiency.In all these patients I enlarged only for extramedullary hematopoiesis.
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The 4th person was a 19 year old male student who took us to the doctor with complaints of leg pain since 2days.I remember seeing this hospital previously.At 5 years of age when he had yellowish discolouration of eyes ,all of us were brought to this same hospital.I remember his Hb being 7gm/dl at that time.Few years later in 2012 again when he had anemia he was adviced for HPLC which showed
Patient HbF 27.7%,HbAo:5.4%,HbA2 -4.7%,HbS:61.3% diagnosed with sickle cell and beta thalassemia trait(in view of increased HbA2)
Father HbF : 2.8 ,HbAo:82.7, HbA2: 4.9,HbS -diagnosed with thalassemia trait (i/v/o inc.HbA2).
Mother HbF : 0.4 ,HbAo:52.4, HbA2:3.4 ,HbS 37.4 - sickling test + diagnosed with sickle cell trait.
Sister HbF : 2.2 ,HbAo:51.5 , HbA2:3.2 ,HbS 37.7 - sickling test + diagnosed with sickle cell trait.
We were adviced to maintain adequate fluids ,avoid NSAIDs,Tab folic acid 5mg.
He had B/L leg pains,chest pain 4years ago.
B/L leg pains 2-3years ago and also recurrent leg pains later on.Episodes of painful crisis previously once in 2-3years but now the frequency increased to 4th time this year.He was again started on IV fluids and pain management by the doctors and they have done examination.They found him to have pallor and I was shocked to know that I was enlarged and I was killing all his blood cells.I did not do anything intentionally.I just killed the cells with abnormal shape and size who got struck,clogged and trapped in my pipelines.These doctors have filed a case of “splenic sequestration” on me.But thank god I did not die of auto splenectomy and splenic infarcts yet.
Case blog link:https://chandanavishwanatham1909.blogspot.com/2023/01/case-4-splenomegaly.html
There was another patient of age 17years ,this girl used to have recurrent respiratory tract infections since childhood,failure to gain weight.On and off yellowish discolouration of eyes since 4 years,generalised weakness.4years ago when we went to hospital with jaundice and anemia ,alien red cells were infused into us.I was fed up going to hospitals from 17years with this girl.All the doctors treated her with various antibiotics,ATT suspecting Tb,acyclovir for herpes,Transfusions and repeated testing with huge panel of blood tests,chest x rays,CT chest.This time we came to Kamineni with the hope that someone will tell us what the problem is .The doctors here have taken a detailed history and examined her.She had pallor and I was moderately enlarged.Her Hb was 3.2,TLC 8200,Platelets 3.0L,RBC 0.8,MCV 116,MCH 37,MCHC 31,RDW 25 ,Total bilirubin 8.16,Direct bilirubin 0.77,PBS:macrocytes,macroovalocytes,anisopoikilocytosis with hypochromia ,her Coombs test was DCT 4+,ICT 1+.Now I remember killing some RBCs tagged with antibodies on and off which I thought were some bad cells which have entered without taking entry ticket.May be that is the reason I got enlarged.Now the doctors filed a case of “extra vascular hemolysis “ on me.I dint understand what my fault was.One of the doctors suspected it to be common variable immunodeficiency with autoimmune haemolytic anemia.Her immunoglobulin levels were found to be low.She was adviced for monthly immunoglobulin therapy ,brief course of steroid and we all recovered well.
Case report link:https://chandanavishwanatham1909.blogspot.com/2023/01/case-5-splenomegaly.html
BMJ publication: https://casereports.bmj.com/content/15/11/e250074.abstract
The next case was an
AN ACT OF BREACH OF FRIENDSHIP ,
Don’t believe if someone says that you are their best friend.Never trust anyone.Are you Wondering why I am talking like this?It is true.I was betrayed by my best friend liver.
This time he was a 41 year old male,Since the age of 11 years he is drinking alcohol.My friend liver kept on shouting at him to stop drinking but he never gave up alcohol .One fine day he started to have yellowish discolouration of eyes,Abdominal distension,pedal edema .I was drowning in alcohol in the abdomen.He took us to the hospital and that is when I came to know that it was not alcohol that I was drowned in ,that was actually called as ascitic fluid by the doctors.The doctors took a detailed history and on examination he had pallor,icterus,They percussed me and the abdomen.I just made some dull sounds which I usually do but I guess there is something wrong in the streets iliac fossa because they also made dull sounds.Ascitic tap was done which showed 22cells,protein 0.5,SAAG 2.18.I got an USG done for myself and came to know that I am grossly enlarged like hulk.This time I did nothing ,I was just sharing my friend liver’s stress.Better I have a intra abdominal mirror so that I can keep a check on my size time to time.The doctors have diagnosed us with decompensated liver disease with portal hypertension.I had a look at the portal vein road and splenic vein road ,the pressures were high.I came to know its all the liver’s fault.I was shocked to see Esophagus with snakes like structures on it.I spoke with esophagus ,she was also complaining that the liver has damaged her beauty with varices.We we’re very much frustrated because if liver was dying why can’t it die alone,why should it damage all of us.I tried calling the liver but the phone was always picked by the regenerating nodules and we don’t know where the actual liver went.That is why I decided to never trust anyone.
But later after few days Mr.Pancreas told me that everything happened because of alcohol and the liver really loved me.So I decided to forgive him.
Case report link:https://chandanavishwanatham1909.blogspot.com/2023/01/case-6-splenomegaly.html
The next case was a 61 year old male,he had involuntary movements of right upper limb at rest and decreased on movement since 3years,dry cough since 10days,SOB grade 2-3.As the doctors examined he had pallor ,icterus,raised JvP,right upper limb pill rolling movements. They found me and liver being enlarged.He was diagnosed with community acquired pneumonia,Parkinson's.
His serial hemograms were done which showed
Day 1
Hb 4.6
TLC 44100
Plts 40,000
Neu 10%
Lym 51%
Mono 37%
MCV 110.9
MCH 33.6
MCHC 30.3
RBC 1.37
Anisopoikilocytosis with hypochromasia,macrocytes,few microcytes and ovalocytes.7NRBCs per 100 WBC’s
WBC:counts increased with shift to left with pro monocytes and monocytosis
LDH 714,LFT was almost normal (Tb 1.39),Retic 1.8 suggestive a hyper proliferation,Serum creatinine was 1.5,Sodium 151,ferritin 219.
On day 2
Hb 4.5
TLC 25600
Plt 42000
Neu 46%
Lym 29%
Mono 25%
PBS:addition to above findings atypical lymphocytes were seen
The doctors suspected it to be a blood cancer.Futher investigations revealed that he has hypercalcemia, hyperuricemia , Hyperphosphatemia,high gamma gap,urine for bence jones positive,worsening renal failure(creat2.3).Bone marrow biopsy was done which showed plasma cell dyscrasia with plenty of plasma cells (>30%).This time I got bigger due to plasma cell infiltration and the amyloid deposition which happens in multiple myeloma.This time I agree that I have done a mistake helping the plasma cells.But I became like this because I was the one who took the blame every time when tried helping and had to prove my genuinity every time .I want to take revenge on this world and the next time I want confuse these doctors and come out of this suffocating abdomen.
Case report link:https://chandanavishwanatham1909.blogspot.com/2023/01/case-7-splenomegaly.html
This 14year old male when he was at age 12 months he had no weight gain,delayed milestones,esophagus was throwing food out,the rectum in the basement was making loose faces on and off.On investigations he had hypokalemia which was later treated and stools had E.Coli,we were given antibiotics.The doctors then suspected Celiac disease and had sent anti endomyseal antibodies test but I don’t really know what the report said and what was wrong with Mr.Ileum.Some dietary changes were made and we got discharged.Since then I don’t know what went wrong with the lungs but he had recurrent colds,cough and fever,we used inhalers for 1year during winter.I also remember at 9years of his age the thyroid gland in the top floor has enlarged .Mrs.Thyroid has produced extra harmones initially but later on don’t know why it started giving up.Intially his TSH was 0.57,later it was >150 and was started on thyroxine supplements.At 12 years of age we all had chicken pox ,resolved in 10days.I thought this is the person with whom I can confuse the doctors with.I started enlarging.Putting aside all the ego I asked liver to help me take revenge.We made a plan.At 12 years of age his liver has gifted him with yellow discolouration of eyes,yellow coloured urine for the Christmas in December 2021.He has taken us to the hospital for our odd behaviour .The doctors on examination found that he was thin built,with icterus, pallor and moderate splenomegaly.Hb was 5 ,also had Leucopenia,thrombocytopenia,PBS :normocytic,normochromic anemia with few microcytes ,tear drop cells,pencil forms,raised total and indirect bilirubin with normal enzymes.Urine for bile salts and bile pigments positive,HIV,HCV,HBsAG,Dengue,Malaria all came negative.DCT came positive.They suspected a spectrum of autoimmune diseases ?Thyroiditis ?AIHA ?CVID.We were started on inj Methylprednisolone IV for 5days and later on oral 30mg prednisolone and tapered over 2months.We we’re also given B12 injections as he had some ?macrocytes in smear. It took me some time to enlarge ,about an year .I was silent till then.Once I became massive I started troubling this child with pain abdomen.He took me to the hospital.His investigations revealed pancytopenia(Hb 7.8,TLC 1,600,platelets 20,000,microcytic hypochromic RBCs),His LFT was showing hypoalbuminemia 2.6 as I asked liver not to cook albumin,PT 17sec,INR 1.2,APTT 33sec,but he kept on cooking clotting factors to confuse the doctors.The kidneys were functioning well,DCT came Positive.When the doctors asked about his family history they came to know about what I have done to his sister.When his elder sister was 2 years I felt hungry and ate all her cells.Doctors at that time tried to deliver me out (splenectomy) but as her parents did not agree ,later on as I was very angry I killed her ,and the case was closed unsolved.
So this time in this boy I am the prime suspect for hypersplenism.Even if they suspect me they can’t do anything to me.I became the most wanted criminal in this case.I asked the lungs,cervical and inguinal lymph nodes to divert the case to malignancy.The doctors have done a cervical lymph node biopsy which was reported as ?malignancy.During his CT chest I asked the lungs to make a halo sign similar to fungal infections.They have done BAL ,BAL fluid reported as ?Malignancy. They have repeated a lymph node FNAC from inguinal region which was reported as lymphohistiocytosis and the pathologists have withdrawn their previous diagnosis of malignancy.They suspected it to be Rosai Droffmans disease.They also suspected liver for Non cirrhotic portal fibrosis and I am a consequence of portal hypertension as in the previous case.I was just watching all the things and relaxing ,sometimes causing him pain abdomen which gave me my psychotic satisfaction.I came to know that they all gonna take me out because of my worst behaviour.Finally I will be free.They all gave consent for splenectomy.All the blood cells started laughing at me.I decided to stay calm because the cells don’t know that once we are out we will be treated as kings.My ancestors told me that long ago when something grew in the basement inside the uterus,when that thing went out of the body,That started crying,everyone was having happy tears.I was waiting to get out of this peritoneum and cry in the hands of my doctor.
One fine day they all brought me out.But unfortunately nothing happened as I expected.The world was better from inside.As soon as I was born they started dissecting me and looking at me under microscope.They also took a part of my friend liver.These pathologists came to know all the story that I was storing some unwanted substances in me to enlarge.Which is the biggest crime I have ever done.Under section ‘storage disorder’ they have arrested me , cut me into pieces,stored some of my pieces in slides.
Good bye folks!Will come back definitely with a bang to take revenge.This is not the end!
Liver:These people gonna suffer for killing my friend.My biopsy was reported as Non cirrhotic portal fibrosis.
Is the main villain still inside laughing at the doctors?
The doctors are now really confused .Is it NCPF or storage disorder or Rosai droffman disease?The mystery continues….!
Case report link: https://chandanavishwanatham1909.blogspot.com/2023/01/case-8-splenomegaly.html
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