The spleen, the strange little organ that can multiply
npr.org
npr.org
As the article says, the spleen filters your red blood cells and platelets. Think of it like a swimming pool filter for your blood stream. It knows which cells to break down because they're misshapen, spherical, instead of the "donut without a hole" shape. RBC's live about three months before degrading like that.
There's just one problem: what happens if your red blood cells are ALL funny-shaped, even the young healthy ones? Why then, your spleen valiantly tries to catch 'em all, like Pokémon, and you end up breaking down your own blood supply, auto-hemolytic anemia.
Welcome to hereditary spherocytosis, which is what I have. Despite its name, it was not hereditary in my case; about 25% of cases are de novo mutations. Incidence is about 1 in 6500, though some milder cases go undetected.
So, after a childhood of jaundice at birth, inexplicable anemia, paleness, and just being really really tired all the time, finally at age six did my pediatrician notice that my spleen was massively enlarged (due to working overtime) and two years later I had to have it out, along with the two accessories they discovered on the operating table. This was the late 1980's so I juuust missed the beginning of the era of laparoscopic surgery, so I have a heck of an abdominal scar.
Poor little spleen, it was only trying to do its job. The fault lay with my blood, not with it.
Meanwhile, I'm immune-compromised for life and have to stay on top of all kinds of vaccines. Note to other spleenless wonders posting here: there's a brand new Meningitis Type B vaccine that just came out in late 2014; get on that. Also Prevnar, Pneumovax, annual flu shots and all the other fun stuff.
Who was working overtime here? Six year old you or the pediatrician? Neither makes sense to me.
Subsequent testing over the next five years showed it, sadly, failed to become active.
For people like me, getting your inoculations is imperative. Annual gp visits help keep it in check.
As for the rest, depending on herd immunity is the answer.
His 9 friends didn't get sick. But they had spleens. He ended up intubated in the ICU and became sufficiently well known in certain circles that I have had conversations with doctors involved in his care on both coasts. Which means he was a terribly interesting patient.
You never, ever want to be an interesting patient...
It's always one of the first things I bring up with a doctor, relevant or not, because without a spleen, my immunity is compromised.
As my GP said, "This stops most people from getting whooping cough, it'll stop you dying from it."
Me? I fell onto the wooden edging of a playground with just the right angle, and just the right force to rupture it. Somehow, it was cleanly torn in half.
When I was about six or seven I fell over in the playground, sliding on ice, and managed to hit the side of my right wrist against the edge of a concrete slab, and gave myself a greenstick fracture. Despite complaining that it hurt, the teachers at the school didn't think there was anything wrong with me, and it was only after school that my father felt my wrist and decided there was a notch there, and I went to the hospital.
That wasn't the most annoying bit. The most annoying bit was that, while spending the day at school writing with a broken arm, all the teachers commented on how much my handwriting had improved.
My teachers weren't sure how to treat me on return: I was still re-learning walking, after being bed-ridden for 5 weeks. So some kind of let me get away with anything, and the others expected me to try harder to catch up.
But again: The school didn't think there was anything wrong with me at first, probably just winded. Then I started puking blood everywhere. Great way to get people to actually listen to a kid.
Also, what is it with not trusting kids with pain? I developed pains in my leg in Year 9. More than a decade later, and my specialists think that was the first symptom of either MS or one of the fibro family.
I know lots of kids complain about minor aches and pains... But give it a bit of attention would you?
You have a number of solid organs, but the spleen and the liver are the most commonly injured, due to their positions on opposite sides of your abdomen.
Splenic ruptures are fairly common with serious abdominal trauma. There is even a grading system...
http://www.aast.org/Library/TraumaTools/InjuryScoringScales....
The grading system is kinda cool. Unfortunately I can't use behind my current WiFi away from home. Maybe you can tell me how I did: The spleen was horizontally rupture into two pieces.
As far as the grading of your spleen... It depends on whether the major vessels leading into the spleen were torn or not, but it certainly sounds like you had a grade 4 or 5 tear (on a scale of 1 to 5).
4 or 5 sounds about right, I lost something around 2 quarts of blood, though that may have more been due to inaction.
All I remember from the ultrasound was thinking the red was really pretty, and then vomiting.
Thanks for sharing your knowledge, it's fascinating stuff.
EDIT: Upon rereading... If you were in primary school, then two quarts would represent a very large fraction of your total blood volume (like, anywhere from 70 to 120%). You'd be very firmly in 'dead' territory at that point (assuming they weren't simultaneously putting more in)
Multiple spleens often result in mis-diagnosis (during radiology) leading to wrong treatment. When you know you have accessory spleens, it is always good to give them a heads up.
I call myself "splenically superior" and argue that it obviously explains my mean personality. :-)
I humbly submit that I deserved downvotes. It is better to disincentive us hopeless clowns on HN, even when we manage to be funny.
Edit: That was quick. :-)
For those who might not recognize it, this derives from a hilarious (and, atypically, authenticated) witticism of Churchill's: http://www.newsweek.com/boneless-wonder-176272.
Had my kids been in Parliament in 1931 they would have said "burn".