September 15, 2005

Q A 29-year-old family member has been diagnosed with ITP (low platelets) and has been treated with three medicines. Nothing holds her count up for very long. Her doctors say the next step is to remove the spleen. What are your thoughts on this? What are the repercussions of not having a spleen?

A ITP –– idiopathic thrombocytopenic purpura –– is a deficit of platelets, also known as thrombocytes. “Penic” indicates deficiency, and “purpura” are the bruises that appear when there are too few platelets. Platelets are the smallest blood cells, the ones intimately involved in forming clots.

In children, ITP often follows a viral infection like a cold, and most children’s platelet numbers are restored to normal in a relatively brief time. In adults, ITP follows a more chronic course. Usually it happens to women between the ages of 20 and 40, and most often a cause isn’t found.

The spleen has a ravenous appetite for platelets that have been coated with antibodies, as they are in ITP. Medicines –– prednisone is often the first one chosen –– can often dampen the antibody-coating action and restore platelet numbers. When medicines fail to achieve a sustained increase in their numbers, then removing the spleen is a logical step.

Thousands of people live healthy, long lives without their spleens. Many professional athletes have had to have a ruptured spleen removed. Contact sports can split the spleen, which has to be promptly taken out to prevent life-threatening haemorrhage.

These athletes continue to play their sports. Without a spleen, people are at an increased risk for certain infections. The chief such infection is one with the pneumococcus germ, a germ that causes pneumonia, meningitis and blood poisoning. There is an effective vaccine for prevention of pneumococcal infections. Your relative will be given that vaccine and other vaccines that confer immunity against the common infections spleenless people can fall victim to.

Q After numerous tests, a paediatric gastroenterologist reluctantly diagnosed my 14-year-old son with intestinal lymphangiectasia. I say “reluctantly” because she felt that the illness was so rare that the likelihood of his having it was remote. A second opinion confirmed the diagnosis, however.

Is this condition permanent? Is there any medicine for it? His low-fat diet helps -– when he stays on it.

A Your son does have an unusual condition. Lymphatics –– lymph vessels —- are similar to arteries and veins, but they’re part of a separate circulatory system, the lymph system. Lymph is fluid that oozes out of blood vessels, percolates around tissues and cells, brings them nourishment and flushes away waste material. The lymphatic vessels are open-ended hoses that suction up lymph fluid and return it to the primary circulation.

Your son was born with lymphatics that are stretched out of shape. Lymphatics are the vessels that fats take to enter the general circulation when they are absorbed by the intestine.

Dilated lymphatics don’t absorb fat normally. The result is diarrhoea, stomach pain and weight loss. Often, people with this condition also lose body protein.

Your son’s condition is unpleasant and serious, but it must not be so bad that it has bothered him from birth or has stunted his growth. You didn’t mention either one. That’s something in his favour.

There is no medicine that can correct the problem, and it doesn’t get better with time. But a diet that eliminates the kind of fat that is difficult for these people to absorb can generally eliminate the diarrhoea and the stomach pain.

Q Our son-in-law was operated on for a hernia. After the operation the doctor said it wasn’t a hernia but a tumour. Then the pathology report came back and said it was fatty tissue that had wrapped around his sperm duct. He and his wife are trying to become pregnant. Could this make him sterile?

Q If the fatty tissue compressed the sperm duct, it might have reduced his sperm count a bit, but being on one side, it was unlikely to have made him sterile. If he is infertile now, it’s not because of this. A sperm count can settle the issue. n

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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