Spleen enlargement (or splenomegaly) is not a normal situation and can be caused by many diseases, including:
- Infections ,
- Diseases of the liver,
- Some types of cancer.
The spleen is a small organ located on the left side of the abdomen, below the rib cage.
The spleen is big as a fist.
What is the spleen? What is your function?
- It is an important blood filter , it helps to remove old and damaged red blood cells and bacteria.
- It is part of the lymphatic system and produces lymphocytes (white blood cells) that fight infection.
- It is a deposit of blood cells and platelets, in cases of necessity.
Many diseases compromise the functionality of the spleen and cause swelling.
The causes of enlargement of the liver and spleen are classified into several groups:
- Infections (brucellosis (1), endocarditis (2), tuberculosis (3), hepatitis B or C , HIV infection , etc.)
- Cancer ( leukemia , lymphoma, or pancreatic cancer )
- Amyloidosis (5)
- Sarcoidosis (6)
- Anemia ou thalassemia .
The infections are divided into:
- Viral infection (eg, mononucleosis),
- Parasitic infection (eg, malaria (7)),
- Bacterial infections (eg syphilis (7)).
Swelling of the spleen due to infection occurs in response to a defense mechanism of the body to fight against the pathogen.
Certain types of cancers such as leukemia and Hodgkin’s disease are diagnosed when the first problems occur in the spleen.
Any other type of cancer that spreads in the spleen can damage and cause swelling.
The cirrhosis and other liver diseases cause portal hypertension (high blood pressure in the portal vein), resulting in splenomegaly (9 – 10 – 11).
Premature destruction of red blood cells due to anemia increases the spleen.
A very low blood platelet level is one of the major risk factors of the enlarged spleen (12).
There are some metabolic diseases such as Gaucher disease, Niemann-Pick disease and Hurler syndrome that cause an enlargement of the spleen.
The obstruction of blood flow can cause swelling in this organ.
In the person suffering from congestive heart failure , the pressure of the splenic vein is high.
This translates into an increase in the size of the liver and spleen.
Some inflammatory diseases such as rheumatoid arthritis and sarcoidosis cause an enlargement of the spleen.
The trauma from this body cause a swollen spleen.
Some medications may cause the spleen to rise temporarily, but the size of the spleen returns to normal when the patient stops taking these medications.
Causes of massive splenomegaly (over 1500 g)
Most authors define massive splenomegaly a spleen that:
- Reaches the iliac crest,
- Cross the midline of the body,
- It weighs more than 1500 grams.
The most frequent causes of massive splenomegaly are:
- Blood diseases ( chronic myeloid leukemia , polycythemia vera , essential thrombocythemia, indolent lymphoma , hairy cell leukemia, beta-thalassemia major ) (16),
- Infectious diseases (visceral leishmaniasis, malaria)
- Metabolism disorders (Gaucher disease – disease causing spleen and liver enlargement, bone and neurological damage) (14 -15-17)
Spleen enlargement does not always cause symptoms.
The following are the main symptoms:
- Pain in the left side of the abdomen radiating to the back
- Feeling of satiety without eating or after eating little
- Unexplained weight loss
- Suffer from frequent infections
- Anemia (low red blood cells)
- High fever in case of infection or intermittent fever if the patient has mononucleosis. This symptom is present even in the case of leukemia and thrombotic thrombocytopenic purpura.
- Frequent bleeding
- Unexplained fatigue
Spleen enlargement in children is caused primarily by:
- Mediterranean anemia or thalassemia ,
- Other infections.
Diagnosis of spleen enlargement
Doctors easily diagnose enlargement of the spleen.
A doctor suspects that there is a problem in the organ when the patient complains of swollen stomach even without eating.
If it is increased, the doctor feels the spleen by palpation in the upper left region of the abdomen. To confirm the presence of splenomegaly (enlarged spleen), physicians prescribe diagnostic tests including:
- The complete blood count to assess the amount and form of:
- White blood cells,
- Red blood cells,
- The blood test to check:
- The values of liver enzymes,
- Antibodies to autoimmune diseases.
High transaminases, high erythrocyte sedimentation rate (ESR), and enlargement of the spleen may indicate mononucleosis .
In the case of mononucleosis and anemia it is also possible to see high indirect bilirubin.
If the doctor suspects cancer such as leukemia or lymphoma, he may prescribe the collection of bone marrow cells for analysis.
- Computed tomography – can identify an abscess, a mass, vascular abnormalities, cysts, changes caused by inflammation, traumatic lesions, abnormalities of the abdominal lymph nodes and liver changes.
- Ultrasonography – is useful for measuring the size of the spleen.
- Magnetic resonance imaging (to track blood flow through the spleen).
Images are studied to determine spleen size increase and causes.
The patient performs blood tests to check the red blood cell count, white blood cells, and platelets.
- In the case of leukemia , there are high white blood cells, but red blood cells and low platelets .
- In the case of Gaucher disease , blood tests show low white and red blood cells and thrombocytopenia.
|Age||Spleen size in cm
(less than or equal to)
|15 – 20 years||12 (for women)
13 (for men)
The treatment of splenomegaly depends on the cause of the disease.
The patient may undergo chemotherapy or radiation therapy when leukemia or Hodgkin’s disease causes enlargement of the spleen.
Until full recovery, rest is advised and avoid the stress that may lower your immunity.
The surgery to the spleen is recommended when:
- This organ is causing serious complications,
- It is not possible to identify the cause,
- The patient does not respond to treatment.
In such cases, a part of the spleen or the entire organ should be removed.
Removal of the spleen does not cure disease, but reduces the effect of low white blood cell count.
Among the complications of enlargement of the spleen is rupture of the spleen, in which case splenectomy is urgently required because this injury can be fatal.
Surgical removal of the spleen is the last option.
A person can live without the spleen, but the chances of developing a serious infection are high.
Prevention of infections
To minimize the risk of infection, vaccination is recommended before and after removal of the spleen.
These injections protect against pneumonia , meningitis and infections of bones, joints and blood.
Some patients need to take penicillin after surgery.
For spleen problems it is important to follow a healthy diet or diet, foods that should be avoided according to the blood type diet are:
- Dairy products
- Fried food
- Sugary and sweet drinks found in the supermarket.
It is recommended to eat fruits, vegetables, vegetables and other unprocessed vegetable products by man.