This study was carried out on forty cases, classified into 3 groups; group I: 10 healthy controls subjects, group II: 20 patients with hepatosplenic
schistosomiasis and group III: 10 bilharzial patients who underwent total
splenectomy. All cases were subjected to clinical examination, abdominal ultrasonography, rectal snips and laboratory investigations which included: stool and urine analysis, complete blood picture, IHAT for
bilharziasis, liver function tests,
viral markers, estimaton of T-lymphocyte subpopulations (CD(+)3, CD(+)4, & CD(+)8) by flow Cytometry,
silver stained blood films to detect argyrophilic inclusions and 99mTc sulphur
colloid splenic scan which was applied to group II only. The present results revealed varying degrees of
hypersplenism (anaemia,
leukopenia &
thrombocytopenia) in GII. Seventy percent of this group was positive for
HbsAg, HCV or both in association with
schistosomiasis. Abnormal red blood cells (acanthocytes, target cells, pitted cells & normoblasts) and inclusion bodies (Howell Jolly bodies, argyrophilic inclusions & pappenhiemer bodies) were detected with different values in GIII. CD(+)4 cells were moderately reduced in GII while they were markedly decreased in GIII. CD(+)8 cells were elevated in GII and returned nearly to the normal values in GIII with decrease in number of total T-lymphocytes. Most patients of GII showed marked squestration of 99mTc labelled R.B.Cs. in the spleen with reversed hepatic/splenic ratio (normally hepatic/splenic ratio is over two). IHAT showed positivity in 90% of patients in GII while it was 50% in GIII. Although total
splenectomy improved the haematological pattern and the
cytopenias, which are prominent features in hepatosplenic
schistosomiasis, yet the immunological profile was still altered. So, it is recommended to perform segmental
splenectomy with retention of a normal mass of functioning residual spleen to preserve more immunological function and to protect against life-threatening occurrence of post-
splenectomy sepsis.