A patient with hereditary spherocytosis undergoes splenectomy. Postoperatively, the spherocytes on peripheral smear persist, but the hemoglobin normalizes. The most likely explanation is:
- A Splenectomy corrects the spectrin defect and spherocytes disappear
- B The spleen was the primary site of destruction of spherocytes; spherocytes remain but are no longer destroyed ✓
- C The liver takes over destruction of spherocytes after splenectomy
- D Bone marrow compensation is no longer needed after splenectomy
Correct answer: B. The spleen was the primary site of destruction of spherocytes; spherocytes remain but are no longer destroyed
Explanation
In hereditary spherocytosis, the underlying membrane protein defect (usually spectrin or ankyrin) persists after splenectomy, so spherocytes continue to form. However, the spleen is the primary organ that traps and destroys rigid spherocytes, so splenectomy eliminates hemolysis and corrects anemia even though the morphological abnormality remains.
Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.
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