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Question
Posted by: Gail | 2003/03/13

EFFECTS OF HIGH DOSAGE CORTISONE TAKEN FOR LAST 2 YEARS

Dear Doc
My question is in two parts:
My husband has been on an average of 60mg of cortisone per day for the last 2 years for treatment for ITP. Everytime they try and reduce the cortisone his platelets drop and the Doctor has to up the dosage again. It looks as if he will be on cortisone indefinately. We are aware of the side effects he is experiencing at the moment but could you please explain any permanent damage that could result.
One of the options he has (which works in about 50% of cases) is to have his spleen removed. Please explain any problems he might experience by not having a spleen.
Thank you
Gail

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Our expert says:
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Gail, by structure and function the spleen is like two organs--an immune one, the white pulp, consisting of periarterial lymphatic sheaths and germinal centers, and a phagocytic one, the red pulp, consisting of macrophages and granulocytes lining vascular spaces (the cords and sinusoids).

Functions of the white pulp: The white pulp generates protective humoral antibodies (inappropriate autoantibodies to circulating blood elements also may be synthesized, as in immune thrombocytopenic purpura [ITP] or Coombs'-positive immune hemolytic anemias). Production and maturation of B and T cells and plasma cells also occur in the white pulp, as in other lymphoid organs.

Functions of the red pulp: The red pulp removes unwanted particulate matter (eg, bacteria, senescent blood elements). In immune cytopenias (ITP, Coombs'-positive hemolytic anemias, some neutropenias), phagocytosis of antibody-coated cells by red pulp macrophages and granulocytes underlies their destruction. The red pulp also serves as a reservoir for blood elements, especially White Blood Cells(WBCs) and platelets. Culling and pitting removes inclusion bodies in Red Blood Cells(RBCs), such as Heinz bodies (precipitates of insoluble globin), Howell-Jolly bodies (nuclear fragments), and whole nuclei from RBCs; thus, after splenectomy, circulating nucleated RBCs and Howell-Jolly bodies are commonly encountered.

Hematopoiesis (the formation and development of blood cells), another function of red pulp, normally occurs in the spleen only during fetal life. Beyond fetal life, injury to marrow sinusoids (eg, by fibrosis or tumors) may allow hematopoietic stem cells to circulate and repopulate the adult spleen and liver.

Post splenectomy patients are more susceptible to serious systemic infections with encapsulated bacteria (eg, Haemophilus influenzae, pneumococci), and should therefore be vaccinated and treated aggressively when an infection with these organisms is
suspected.

Hope this answered your question (please let me know if it didn’t). Good luck.

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

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