Splenic salvage quantified by uptake of heat-damaged radiolabeled red blood cells: experimental and clinical studies

We evaluated a noninvasive radionuclide technique to quantify splenic trapping function, which is a key step in the disposition of blood-borne particulates such as poorly opsonized encapsulated microorganisms implicated in hyposplenic fulminant sepsis. Using computerized external gamma imaging, the percentage of splenic uptake of heat-damaged radiolabeled red blood cells was determined in adult Sprague-Dawley rats with eutopic (partial splenectomy) or ectopic (single or multiple autotransplantation) remnants or whole spleens, and in 14 patients with either an intact spleen or splenic remnants after treatment for trauma or hypersplenism. The masses of both eutopic and ectopic remnants correlated directly with the percentage of heat-damaged red blood cell uptake, but the percentage of uptake per gram was higher in eutopic remnants, paralleling more vigorous compensatory growth. In patients, the percentage of heat-damaged red blood cell uptake by remnant spleens was similar to that seen in the rats and, in addition, was supernormal in those with congestive splenomegaly. This noninvasive technique both provides a vivid biplanar image and quantifies blood-borne particle trapping, which is a key splenic function. A heat-damaged red blood cell uptake of less than 15 percent after splenic salvage suggests marginal splenic performance and continued vulnerability to overwhelming sepsis.