Patients with ulcerative colitis and coeliac disease who had been shown by impaired clearance of heat damaged red cells to have diminished splenic phagocytosis, were examined for evidence of more generalised reticuloendothelial malfunction by measuring their circulatory clearance of micro-aggregated albumin. Although in animals micro-aggregated albumin is largely removed by Kupffer cells, we found impaired clearance in otherwise normal subjects who had previously had surgical splenectomy. In patients with hyposplenism because of bowel disease there was no additional impairment of micro-aggregated albumin clearance, indicating that their hyposplenism is an isolated phenomenon and not part of a generalised reticuloendothelial atrophy. Patients with coeliac disease and normal splenic function had increased reticuloendothelial catabolic activity; this was not present in patients with coeliac disease and abnormal splenic function.
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