Splenomegaly (Enlarged Spleen): Symptoms, Causes and Treatment

Splenomegaly refers to a condition where a person’s spleen gets enlarged. The spleen is a small organ that produces white blood cells and antibodies and is located right behind the left rib cage. Splenomegaly may occur for several reasons and lead to severe complications if left untreated.  

Overview

The spleen is a small organ located right behind your left rib cage. An enlarged spleen can be caused by a variety of factors, including infections, liver illness, and various malignancies. Splenomegaly is the medical term for an enlarged spleen.

Your lymphatic system includes your spleen. It aids the immune system by storing white blood cells and assisting in antibody production. This organ is located beneath your rib cage on the left side of your body. It’s in charge of:

• Antibody-coated bacteria are filtered.
• Ancient red blood cells being reprocessed
• Iron recycling in haemoglobin 

Because it produces two types of white blood cells: B cells and T cells, the spleen is critical in your body’s defence against infection. Bacteria and illnesses are fought off by white blood cells. The spleen is generally approximately the size of a fist, but it can grow to be considerably larger if it is enlarged.

How does the spleen work?

As already mentioned, the spleen is a soft and spongy organ located behind the left ribs and aids the immune system. The organ’s size depends upon the individual’s height, weight and sex. It performs several essential functions, such as storing red blood cells and platelets, producing white blood cells, and filtering out old and damaged cells. In total, the spleen aids the immune system in fighting the human body from attacking foreign particles and organisms.  

What are the most important facts to know about splenomegaly?

Splenomegaly occurs when the spleen enlarges more than 12 cm in length and 400 grams in weight. In massive splenomegaly, the length can be more than 20 cm, and it can weigh more than one kg. The abnormal size of the spleen affects its proper functioning, making the condition a life-threatening issue. Apart from the signs and symptoms related to the underlying disease, people with splenomegaly may experience mild pain in the abdominal region.  

In most cases, a physical examination can help detect an enlarged spleen. But the condition is confirmed with lab-based tests. If the case is severe, the patients may be advised to take vaccinations against certain bacteria to avoid infections.  

 What should I look out for?

Some people with an enlarged spleen have no symptoms and are only diagnosed during a normal medical examination. If you’re extremely thin, you might be able to feel your enlarged spleen through your skin. 

A sense of pain or discomfort in the upper left side of the abdomen, where the spleen is located, is a common sign of an enlarged spleen. You may also feel full after only a tiny amount of food has been consumed. This occurs when the spleen enlarges to the point where it presses against the stomach.

If your spleen presses on other organs, blood flow to the spleen may be affected. Your spleen may be unable to filter your blood effectively as a result of this. If your spleen grows too large, it may begin to remove an excessive amount of red blood cells from your blood. Anaemia is a disorder that occurs when the body’s red blood cells are insufficient. Infections may become more common if your spleen can’t produce enough white blood cells as a result of its expansion.

What are the symptoms of Splenomegaly?

Generally, splenomegaly shows no prior indicators. But in some cases, the patients may have frequent infections, bleeding, feeling of fullness without eating, pain in the upper belly that spreads to the left shoulder and low red blood cell count.

 What can be the causes of splenomegaly?

Sometimes, the spleen enlarges temporarily and subsides as the cause is treated. Therefore, it is important to know the cause of splenomegaly for treatment:

• Liver diseases such as liver cirrhosis.
• Viruses infect the body, causing diseases like mononucleosis.
• Certain metabolic disorders like Niemann-Pick disease and Gaucher’s disease.
• Bacteria causing endocarditis or syphilis.
• A blood clot decreases the blood flow to the spleen.
• Infections caused by parasites like malarial parasites.
• Predisposing conditions like myeloproliferative neoplasms, leukemia or any lymphomas
• Hemolytic anemia that destroys the RBCs.

 When to see a doctor?

It’s critical to schedule an appointment with your doctor if you’re experiencing symptoms of an enlarged spleen. See your doctor as soon as possible if you have significant pain in the upper left side of your abdomen, or if the pain worsens when you breathe. 

Are there special considerations for people with enlarged spleen?

An enlarged spleen is a potentially life-threatening disease that forces the people affected to refrain from various activities that may cause issues. Participating in contact sports such as football, hockey, and basketball should be avoided since it may lead to rupturing of the spleen. Any heavy activities leading to this rupture must be stopped until the ailment is completely cured.   

 Is an enlarged spleen serious?

An enlarged spleen is a dangerous condition that requires immediate medical care. Heavy activities can rupture the enlarged spleen, causing blood flow that can be fatal. Splenectomy or removal of the spleen is the solution for this. An abnormality in the spleen may cause issues with the circulation of white blood counts and platelets, making the patient prone to more infections and diseases. The disturbed flow of red blood counts may also cause anemia.

 What is a massive splenomegaly?

In some patients, the spleen can grow more than 20 cm in length and 1 kg in weight. Such cases are known as massive splenomegaly. Patients with this condition will have the spleen grown across the midline to the right side of the abdomen. Conditions like chronic myelogenous leukemia, myelofibrosis and splenic marginal zone lymphoma, as well as infections, such as malaria, can cause this condition.

How do you know if your spleen is enlarged?

People with enlarged spleen may experience mild discomfort in the lower abdomen, decreased appetite, and a feeling of fullness even without eating food. It is due to the spleen compressing the stomach. Some people experience fatigue and episodes of bleeding and infections. They may also show the symptoms of underlying diseases if they have any. 

 Impact of Splenomegaly

Splenomegaly disturbs each of the above-mentioned functions. An enlarged spleen starts filtering both abnormal and normal RBCs. This reduces the total cellular volume in your blood, increasing platelet trapping. This can eventually cause a clogging of the spleen with too many blood cells and affect its normal functioning. Sometimes, the size of the spleen increases more than its potential blood supply. This destroys parts of the spleen.

Commonly, splenomegaly is detected during a general physical examination, as it does not cause any symptoms. To identify the underlying cause, doctors usually recommend blood tests and imaging. The treatment mainly focuses on treating the cause. Surgical removal of the spleen is sometimes mandatory.

Splenomegaly can be easily confused with ‘hypersplenism’. The term connotes overactive function by a spleen of any size. This does not necessarily mean that your spleen is enlarged.

How do you know if you are at greater risk of developing splenomegaly?

At any age, anyone can acquire an enlarged spleen, however certain groups are more vulnerable, including:

• Infections such as mononucleosis affect children and young adults.
• People with Gaucher disease, Niemann-Pick disease, and other inherited liver and spleen metabolic diseases
• People who reside in or travel to malaria-endemic areas

What are the complications that can occur due to splenomegaly?

Splenomegaly can lead to complications like-

• Infection and anemia.
• increased bleeding and frequent infections.
• Ruptured spleen.

It is a very soft organ, making it more susceptible to traumatic damage. The possibility increases in splenomegaly. This can cause fatal internal bleeding.

What is the method of diagnosing splenomegaly?

A routine physical exam of the abdomen usually detects splenomegaly. Usually, the spleen cannot be felt by the doctor on examination, unless you are very thin. There is nothing to worry about if so, as it might still be healthy and normal in size. The lack of abdominal fat makes it more palpable.

Any suspicious findings are backed-up by the following tests:

• Blood tests: CBC is done as a primary test. A complete blood count gives you the total count of RBCs, WBCs, and platelets in your blood, helping the diagnosis.
• CT Scan and ultrasonography: It can help measure the exact size through advanced imaging. It also reports any pressure on other internal organs.
• MRI: Magnetic Resonance Imaging is an imaging technique that helps evaluate the blood supply to the spleen.

The other tests that may occasionally be required are:

• Liver function tests (LFT).
• Bone marrow examination.
• Bone marrow biopsy &/or bone marrow aspiration.
• FNAC or fine-needle aspiration cytology is very rarely performed given the chances of bleeding complications.

When the cause cannot be detected, surgical removal is recommended. A pathophysiological examination then follows, which can determine the exact cause of the splenomegaly.

Is there any treatment for splenomegaly?

The treatment is done by treating the cause. In case the cause could not be detected, your doctor will suggest to wait and watch. Follow your doctor’s instructions for any required re-evaluation and follow-up.

Your doctor might recommend splenectomy (surgical removal of the spleen) if any serious complication occurs or if the cause is unknown for a long time. In long-lasting or complicated cases, surgery might have the best prognosis.

Splenectomy usually follows temporary leukocytosis (an increase in the number of white cells in the blood). It is a physiological response to the removal of the spleen. Your doctor might do some tests to rule out postoperative sepsis, a complication of splenectomy.

As splenectomy can cause serious and sometimes life-threatening infections, sometimes, radiation treatment to the spleen can be used to shrink it and relieve the symptoms. This can be an alternative to surgery.

Lifestyle modifications and prevention of complications

The following tips can help you keep your spleen safe:

• Be up-to-date with your vaccinations
• Avoid sports that are rough such as football, soccer, and hockey as they can rupture the spleen.
• Prevent serious trauma to your spleen due to a car accident by wearing a seat belt.

Conclusion

Slight differences in spleen size are frequent and not to be concerned about. However, if you feel your spleen is enlarged or if you’re experiencing any organ-related issues, you should contact a doctor as soon as possible. If an infection is causing this temporary spleen enlargement, it’s best to get it recognised and treated as soon as possible. 

The spleen can be removed in severe cases of spleen malfunction. You’ll be more susceptible to diseases, which means it’ll be even more vital to stay up to date on vaccines and other preventive measures, such as washing your hands carefully and consistently or avoiding persons who may be contagious.

FAQs: Frequently asked questions

 What are the symptoms of splenomegaly?

Usually presents with no symptoms. However, some symptoms that can be noted are: pain or fullness in the left upper abdomen, feeling full without eating or after eating only a small amount, anemia, fatigue, frequent infections, easy bleeding.

Is splenomegaly painful?

Not always, however, pain or fullness in the left upper abdomen that may spread to the left shoulder is not uncommon. If the disease is severe, the pain gets worse when you take a deep breath.

Can splenomegaly be cured?

Depending on the reason for an enlarged spleen, it can be cured or will likely get back to its normal size when the underlying condition heals. In general, in splenomegaly, owing to infectious mononucleosis, the spleen goes back to its normal size as the infection reduces.

What foods should you avoid if you have an enlarged spleen?

If you have an enlarged spleen, you need to avoid the following:

• Avoid eating food items that are too cold or too raw, as a diet with high water content can lead to cellulite buildup and inflammation.
• Avoid excessive sugar intake, as it will overwork your pancreas and affect the spleen.
• Follow a regular eating pattern as erratic eating habits can cause pain to the spleen.

What is the most common cause of splenomegaly?

Some of the common causes of an enlarged spine are:

• Bacterial (syphilis, endocarditis)
• Viral infections (mononucleosis)
• Liver conditions like cirrhosis
• Parasite-borne diseases like malaria

What is the average size of spleen?

In general, the size of the spleen (a part of the lymph system) in an adult is around 3-inches wide, 5-inches long, and 1.5-inches thick. It weighs about 6 ounces. Men and taller people tend to have larger spleens than women and shorter people, respectively.