In the late stages of sickle cell anemia, the spleen is described as?

In the late stages of sickle cell anemia, the spleen typically undergoes atrophy due to repeated splenic infarctions and functional asplenia. As a result, the spleen is often small in size. When imaging, such as ultrasound, is performed, the remaining splenic tissue can show increased echogenicity. This is due to the fibrotic changes and calcifications that occur from the damage and scarring of the splenic parenchyma over time.

The small size of the spleen is a significant finding in patients with sickle cell disease because it reflects the loss of splenic function, which is crucial for producing immune responses. Thus, in the context of sickle cell anemia, a small and echogenic spleen correlates with the chronic changes that occur in the organ due to the disease process.