Red Robin #4 and #5: A Medical Review
In the closing panels of Red Robin #4, Tim Drake is stabbed in the abdomen with a sword by the villainous Widower. In the next issue, it is revealed that his injury required the removal of his spleen.
Found in the upper left aspect of the abdominal cavity, the spleen is roughly the size of a grapefruit and serves several important functions: It removes old and damaged blood cells from the circulation, as well as removing harmful bacteria. It assists the immune system by acting as a large lymph node. It stores extra blood to act as an emergency reserve in case of severe blood loss.
Both blunt and penetrating abdominal trauma can injure the spleen. Penetrating trauma can lead to splenic lacerations. Blunt trauma can rupture it. Unfortunately, the spleen is very difficult to repair — it was once described to me as having the consistency of a sopping, water-logged sponge. Imagine trying to sew that back together. Often the only treatment for a severely damage spleen is splenectomy (removal of the spleen), leaving the patient asplenic (without a spleen).
The main concern in people lacking a spleen is an increased risk of infection. This is not just a slight increase in risk, but a significant increase in the risk of serious infections. In the worst case scenario, there is a condition known as OPSI (overwhelming post splenectomy infection) that can be fatal within just a few hours.
Asplenic individuals are susceptible to a wide variety of germs, but the three most concerning are:
1. Bacteria that have a thick protective capsule. These bacteria include pneumoccocus (a cause of pneumonia and other infections), meningococcus (a cause of meningitis), and Haemophilus influenzae (another cause of meningitis, among other nasty infections).
2. Capnocytophaga canimorsus, a bacteria found in dog bites.
3. Parasites that like to hide within red blood cells (malaria is the main one, but also babesiosis and ehrlichiosis, rare tick-borne infections).
Asplenic individuals need to be aggressively immunized against the riskiest bacteria. They will require the pneumococcus, meningococcus, and Haemophilus influenza vaccines. The pneumoccocal vaccine may need to be repeated every 5 years. Additionally, pediatric patients who lose their spleen need to be started on daily broad spectrum antibiotics for the next 2-5 years. Those who are considered particularly high risk for infection may need daily antibiotics for the rest of their life.
October 23rd, 2009 at 12:02 am
Hey, thanks for the quick review. I was just realising how much of my Hematology I’d forgotten since the exam. A nice review to re-clue me in on a lot of spleen-related stuff.
October 23rd, 2009 at 2:20 am
Watch this never be addressed, ever.
Then again, they clone organs for Damien all the damn time, so they should be able to get Tim a new spleen or something… of course, that’s probably contingent on Tim’s agreement to work for Ra’s. Creepy jerk.
October 23rd, 2009 at 8:35 am
Not to mention, of course, this is a universe with Lazarus Pits (or have they “destroyed all of them” again?) and various healers, so he still has options.
October 23rd, 2009 at 10:11 am
I’m sure it will be “stealth-conned” out of existence, but off-handed writer sloppiness like this really, really irritates me, particularly with the Internet. Take five minutes and Google, for cryin’ out loud. And if you can’t be bothered to do that, don’t “remove” organs that add nothing to the plot other than a throwaway line of dialogue.
October 23rd, 2009 at 10:29 am
So… is this a good depiction of an asplenic individual, or a bad one? Just curious.
–Rawr
October 23rd, 2009 at 11:43 am
Official Comment
Only time will tell. It could be good or bad — or be conveniently ignored. I suspect the latter.
October 23rd, 2009 at 12:20 pm
I just wanted to add that both “splenectomy” and “asplenic” are fun words to say.
October 23rd, 2009 at 2:02 pm
crap. i just took a test with a question about this. got it wrong.
October 23rd, 2009 at 6:23 pm
@oyi,
Man, I never got tests on comic books when I was in school…..
October 23rd, 2009 at 7:14 pm
Don’t worry, Tim is simply being lied to in the hope that he’ll feel more indebted to Ra’s Al Ghul’s agents for saving his life. His spleen is fine, and that’s why they’ll never mention or refer to the loss of it ever again, nor depict any of the after-effects. Bring on the no-prize!
October 26th, 2009 at 12:05 pm
And according to recent research, the spleen may assist in healing heart damage.
http://www.sciencedaily.com/releases/2009/07/090730141557.htm
October 26th, 2009 at 3:57 pm
We are discussing the after effects of Robin losing a spleen, but…
Since I am a little behind on the batverse chronology, does anyone know if there have been depictions of the long term effects of Batman having his back broken by Bane some years ago…?
October 27th, 2009 at 9:55 am
No more than we’ve had any coverage of the long-term effects of years of high stress, partially healed injuries, and no sleep on Batman.
Regarding the spleen, I think that one of the reasons it was chosen (other than that it’s just a fun word to say. Spleen. *snigger*) is that it’s one of the organs, other than the appendix, most likely to be mentioned as having been removed (probably due to the difficulty of repair) in things like news stories. So, in the back of our minds, the spleen has gotten marked as a relatively non-essential organ.
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