What changes occur in RBCs after splenectomy?

When the spleen is removed (a procedure called splenectomy), the body loses its main filter for abnormal or aged red blood cells. As a result, several noticeable changes appear in RBCs circulating in the blood.

Without the spleen, old or misshapen RBCs that would normally be removed stay in circulation longer. Under a microscope, doctors can see abnormal RBC shapes such as:

• Howell–Jolly bodies (nuclear remnants)
• Target cells (cells with a bullseye appearance)
• Pappenheimer bodies (iron granules)

These abnormalities happen because the spleen is no longer available to remove or “polish” the cells. The lifespan of RBCs may slightly increase, but the overall blood quality decreases because defective cells circulate longer.

Additionally, people without spleens are more prone to certain infections, especially from encapsulated bacteria like Streptococcus pneumoniae. That’s because the spleen also helps produce antibodies and remove bacteria from the blood.

To manage this, patients who undergo splenectomy are often advised to get vaccines and sometimes preventive antibiotics. While other organs like the liver take over some filtering functions, they cannot fully replace the spleen’s unique ability to maintain the health and quality of red blood cells.