Hypersplenism
The spleen is an organ in the upper left of the abdomen. One of its chief functions is to remove old red blood cells, known as erythrocytes, from the bloodstream on a regular basis. In hypersplenism, the spleen begins to rapidly and uncontrollably remove red blood cells which are still in working order, resulting in serious medical problems.
Causes of Hypersplenism
The overactive functioning of the spleen in hypersplenism may be a primary or secondary condition. When it is a primary condition, it may result in the development of other disease processes. When it is a secondary condition, hypersplenism is itself the result of another underlying disease. Conditions that may cause hypersplenism include:
- Cirrhosis or other chronic liver disease
- Malaria
- Lupus
- Tuberculosis
- Viral infections, such as mononucleosis
- Rheumatoid arthritis
- Polycythemia vera, a bone marrow disease
- Various connective tissue and inflammatory diseases
- Tumors
Blood disorders such as lymphoma,leukemia and hemolytic anemia may also contribute to hypersplenism.
Symptoms of Hypersplenism
Hypersplenism presents with a number of symptoms, the most noticeable of which is usually splenomegaly, or an enlarged spleen. An enlarged spleen may cause the patient to feel prematurely full while eating or to experience abdominal pain, particularly on the left side. Other symptoms of hypersplenism of may include:
- Soreness or bruising, especially on the left side of the abdomen
- Susceptibility to bacterial infections
- Fever, weakness or heart palpitations
- Ulcers of the mouth, legs or feet
- Bleeding in the gastrointestinal or urinary tract
Unexplained bleeding from the nose or other mucous membranes may also be symptoms of hypersplenism.
Diagnosis of Hypersplenism
The physician may diagnosis splenomegaly upon physical examination, since the enlarged spleen is often easily palpated. This enlargement may cause the doctor to suspect hypersplenism. A patient history of infectious or inflammatory disease may also provide a clue to hypersplenism. The first diagnostic test performed is a complete blood count (CBC), since a low level of red or white blood cells, or of platelets, may indicate the presence of this condition. Other diagnostic tests may be conducted, including a liver function test, a CT scan, an ultrasound scan or a bone marrow biopsy.
Treatment of Hypersplenism
The treatment of hypersplenism will depend on whether it is a primary condition or a complication of another disease process. If it is a secondary condition, the underlying disorder must be addressed. If primary hypersplenism is diagnosed, there are several possible treatments which may include:
- Splenectomy, or removal of the spleen
- Partial splenectomy, or removal of part of the spleen
- Splenic embolization, or blocking the splenic artery to shrink the size of the spleen
The prognosis of a patient with hypersplenism varies depending on the cause of the condition. If the underlying cause can be successfully treated, the patient may fully recover. If, however, splenectomy or splenic embolization are required, the prognosis is more guarded because of the possibility of infection. Usually with proper care, the patient can live a relatively normal and fulfilling life.
Complications of Hypersplenism
It is necessary for patients with an enlarged spleen to avoid contact sports or any high risk activities that might cause the spleen to rupture. Since the spleen plays an important role in the immune response, the greatest risk to patients whose spleens are removed or not functioning properly is sepsis, an overwhelming systemic infection. Patients whose hypersplenism has been treated with a splenectomy or splenic embolization must be vaccinated against specific infections. They must also, wherever possible, avoid exposure to infections, and, particularly when patients are infants or children, take an ongoing course of antibiotics.