Splenomegaly (enlarged spleen): what it is, causes, symptoms

What is splenomegaly?

Splenomegaly is an increase in the size of the volume occupied by the spleen . The spleen is an organ that serves as a blood reservoir, in addition to cleaning blood from old red blood cells through phagocytosis. It is also an important part of the lymphatic system and is responsible for the production of white blood cells in the body.

This organ normally has around 200 mL of blood, but it can expand to hold an entire liter or contract until it has only 50 mL of blood inside it. Its size in adults is usually 12 centimeters for women and 13 centimeters for men. Spleens larger than this are in a state of splenomegaly.

Rarely does splenomegaly show symptoms, which usually appear only when the expansion is marked. Even when symptoms are present, they do not give an indication of the cause of the increase.

Index – in this article you will find the following information:

  1. What is splenomegaly?
  2. Causes
  3. Hypersplenism secondary to splenomegaly
  4. Groups and risk factors
  5. Symptoms
  6. How is the diagnosis made?
  7. Is splenomegaly curable?
  8. What is the treatment?
  9. Medications for splenomegaly
  10. Prognosis
  11. Complications
  12. How to prevent


Several conditions can lead to an enlarged spleen. Some of them are:


Immune responses can start from the spleen, which can swell due to this. Infections like mononucleosis cause this organ response.

Increased red blood cell destruction

Some diseases such as spherocytosis or thalassemia major can cause an increase in the destruction of red blood cells. This increase in activity can cause an enlarged spleen.

Infiltrative diseases

Sarcoidosis and certain types of neoplasms can cause the organ to enlarge.


Tumors can cause an enlarged spleen. The lymphoma and leukemia  in particular are frequent causes of splenomegaly.

Chagas disease

Chagas disease causes swelling in the lymphatic system, including the spleen, which increases in size.

Visceral leishmaniasis

This disease, caused by a parasite, causes swelling of the liver and spleen.

Gaucher disease

Gaucher disease is a genetic condition. The main symptom of it is the severe enlargement of the spleen. This disease is one of the cases in which the condition has symptoms such as swollen abdomen.


Amyloidosis causes accumulation of amyloid protein in the organs and can lead to an enlarged spleen.

Portal hypertension

Some diseases that cause liver enlargement due to blood pressure are liver cirrhosis  and pancreatic cancer . It is called portal hypertension because it is in the vein.


Myelofibrosis is characterized by a genetic alteration that causes fibrosis (or scarring) of the bone marrow. The region is responsible for the production of blood cells and, therefore, when the disease manifests, changes in cell concentrations (red blood cells, leukocytes and platelets) occur.

The enlarged spleen is one of the most prevalent symptoms in patients diagnosed with myelofibrosis, and in most cases, the organ occupies the entire left half of the abdomen and can reach the iliac fossa (pelvic bone).

Hypersplenism secondary to splenomegaly

This condition occurs due to the enlargement of the spleen. The hypersplenism  is the increased activity of the spleen.

When it grows, its ability to retain and store blood cells grows together. This means that it starts to retain more erythrocytes, leukocytes and platelets, work that it already does, but to a lesser extent when it is normal size.

The lack of these cells in the circulation can lead to anemia (erythrocytes), leukopenia (leukocytes) and thrombocytopenia (platelets).

Groups and risk factors

Many disorders cause the spleen to grow. However, some people are more likely to develop the condition.


Due to the greater chance of developing liver disease and liver cirrhosis, alcoholics are at risk for the development of splenomegaly.

Cat Owners

The cat scratch disease  or Teeny disease  is often benign disease caused by the bacterium Bartonella hensela . The bacteria is carried by stray cats or kittens and is common.

It can be transmitted to humans through the scratch and, after the first infection, the body usually becomes immune. Symptoms, which can include splenomegaly, usually disappear without treatment in less than a week.

HIV positive and other immunity conditions

HIV , lupus and other conditions that reduce a patient’s immunity can increase the chances of developing splenomegaly.


Thalassemia is a type of anemia that can cause splenomegaly.

Lymphoma and leukemia

Both types of tumors are frequent causes of an enlarged spleen.

Gaucher disease

Gaucher disease is a genetic disease capable of enlarging the patient’s spleen.


Symptoms of splenomegaly are not always present, but there are cases where they do appear. They are as follows:


The enlarged size of the spleen can influence the movement of the diaphragm, causing hiccups.

Increased abdominal volume

When the spleen is quite expanded, it is possible to notice an increase in the volume of the abdomen. This symptom is very noticeable in Gaucher disease, which causes a large enlargement of the spleen.

Reduced hunger

Due to the volume of the spleen, it can displace the stomach, which can lead to early satiation. That is, the patient is satisfied with less food.

Pain in the spleen region

In cases of cancer and splenomegaly caused by infections it is possible that there is pain in the region of the spleen, called the left hypochondrium. It is just below the ribs. This pain can be accompanied by fever . In cases of very severe pain, it is possible to have an infarction in the spleen.


Due to hypersplenism, the patient may go pale. However, it is more common to notice, through blood tests, the lack of blood cells that the spleen retains.

How is the diagnosis made?

The diagnosis can usually be made through several exams by the general practitioner or hematologist. Are they:

Physical exam

During the physical examination, the doctor looks for signs of disease in the patient’s body. Through palpation he can identify the exacerbated size of the organ. It is important, however, that there are more tests to confirm the diagnosis as there are cases of accessory spleen , an anatomical variation that affects approximately 30% of people, presents as a small nodule in the spleen tissue and is harmless.


Through ultrasound, it is possible to identify changes in the size of the organs.

Computed tomography (CT)

Computed tomography can also identify changes in organ size. In addition, it is used to help find the causes of the enlarged spleen.

Magnetic resonance imaging (MRI)

Like computed tomography, magnetic resonance imaging can deepen the knowledge about the causes of the organ enlargement. The advantage of MRI is that it also shows blood flow through the spleen, being able to identify problems such as possible thrombosis .


Using lightly radioactive material, scintigraphy is able to identify changes in the organs and, in the case of splenomegaly, it is able to determine whether the spleen is accumulating or destroying large amounts of blood cells.


Blood tests can be used to identify decreases in platelets, leukocytes and erythrocytes.

Is splenomegaly curable?

The cure for splenomegaly is to cure or treat the condition that causes it. In some cases, removal of the spleen may be necessary to avoid complications such as severe anemia, splenic infarction and sepsis .

What is the treatment?

In order to reduce the spleen, it is necessary that the condition that causes this increase be treated. The doctor will seek to eliminate the cause. If it is not possible or if the spleen is doing a lot of damage by destroying many blood cells causing severe anemia, splenectomy can be performed.


The spleen removal surgery is rarely performed because, although it is possible to live without the organ, there are great risks in this, such as susceptibility to serious infections, since the spleen is important for the immune system. However, there are some cases in which surgery is recommended:

  • In cases where the spleen is compressing other organs and causing a lot of pain;
  • When parts of the organ bleed and die;
  • When the spleen is destroying too many blood cells to leave the body vulnerable to infections.

Patients undergoing splenectomy should be vaccinated against infections caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. This vaccine must be repeated every 5 years.

It may be necessary to use antibiotics such as penicillin and erythromycin in a preventive manner right after the surgery, because at that moment the patient is very vulnerable to sepsis.


Instead of surgery, it is possible to perform radiotherapy, which can reduce the size of the spleen in some situations.

Medications for splenomegaly

The medications used during the treatment of splenomegaly are different depending on the cause  of the increase. However, in the case of surgical removal of the organ, antibiotics may be necessary. Are they:

  • Erythromycin ;
  • Amoxicillin .


NEVER  self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.


The prognosis depends on the condition that caused the spleen to enlarge, however, in most cases, spleen reduction can be achieved and there are no sequelae.

In cases where a splenectomy is necessary, the patient will need to take special care as his body will be more susceptible to infections. The vaccine should be redone once every five years and the patient can take antibiotics in low doses for life.


If ignored, the enlarged spleen can cause serious problems.

Organ rupture

Impacts on the abdominal region in splenomegaly patients can cause the organ to rupture, which can lead to internal bleeding.

Necrosis and heart attacks

When the organ is too large, it can bleed and die, as well as having heart attacks that lead to necrosis of the organ. Due to the damaged immune system due to the condition of the spleen, this can progress to sepsis (generalized infection).


The patient may develop severe anemia due to the retention of platelets that the spleen performs, in addition to suffering from severe pain.

Do not ignore!

Splenomegaly is not a condition that should be ignored. Spleen pain can happen during physical exercise due to irregular breathing, however, at rest, it should not appear. If you experience pain in your spleen when at rest, see a doctor.

How to prevent

It is not possible to prevent splenomegaly. The condition can appear due to numerous causes. However, some precautions can be taken to reduce the risks.

Do not overdo the alcohol

Taking care of the liver helps prevent splenomegaly. Liver cirrhosis is one of the causes of the condition.

Doing check-up exams

Finding diseases that cause splenomegaly can prevent the organ from growing as the cause will be treated. Visit your doctor regularly.

Splenomegaly is a condition that can be a sign of several different diseases. Its symptoms are rare and mild. Usually treating the cause solves the problem, but when ignored, the large spleen can cause serious problems. Share this text with your friends to let them know more about this condition!