Discuss the rationale for splenectomy as part of the staging laparotomy in Hodgkin's Disease. Fluid resuscitation results in stabilization of blood pressure and diagnostic peritoneal lavage reveals gross blood on aspiration. The patient is taken to the operating room for exploratory laparotomy and on exploration, the only significant injury is a 4 cm laceration of the anterior surface of the upper pole of the spleen. There is moderate bleeding noted at time of exploration. The past medical history is otherwise unremarkable and the patient takes no medications.
Physical examination reveals multiple areas of echykmosis on the hands and forearms bilaterally.
The remainder of the exam is unremarkable. Laboratory studies reveal a normal hemoglobin, hematocrit and white blood cell count but a platelet is seen on the peripheral blood smear. PT and PTT are normal but bleeding time is prolonged. Discuss the etiology of this disease process. Approximately 70 percent of the cells on peripheral smear are noted to be spherocytes.