Splenomegaly - Symptoms, causes and treatment

Splenomegaly is an enlargement of the spleen due to disease or infection.Normally, the spleen is only 1–20 cm in size, weighing about 500 grams. However, in patients with splenomegaly, the size of the spleen can be more than 20 cm with a weight reaching more than 1 kg.

The spleen is an organ located in the abdominal cavity, just below the left rib. Its functions are diverse, such as filtering and destroying damaged blood cells from healthy blood cells, storing reserves of red blood cells and platelets, and preventing infection by producing white blood cells.

Splenomegaly that is classified as severe can cause all of the above functions to be disrupted, so the patient will also be susceptible to infection or bleeding. In addition, a very large spleen is also more prone to rupture and cause heavy bleeding in the stomach.

Causes of Splenomegaly

Splenomegaly can be caused by disease or infection, such as:

  • Viral infections, eg mononucleosis
  • Parasitic infections, such as malaria
  • Bacterial infections, including syphilis or endocarditis
  • Blood cancer, such as leukemia
  • Lymphoma (cancer of the lymph nodes)
  • Liver disorders, such as cirrhosis or cystic fibrosis
  • Metabolic disorders, eg Gaucher and Niemann-Pick . disease
  • Blockage of the blood vessels of the spleen or liver caused by a blood clot or pressure from elsewhere
  • Blood disorders that cause red blood cells to be destroyed faster than they are formed, including thalassemia and sickle cell anemia
  • Inflammatory diseases, such as lupus, sarcoidosis, and rheumatoid arthritis
  • Abscess or collection of pus in the spleen
  • Cancer that has spread to the spleen
  • Injuries, for example from impact during sports

Symptoms of Splenomegaly

In most cases, splenomegaly can occur without symptoms. However, some patients experience symptoms in the form of pain in the upper left abdominal area. This pain can be felt to the left shoulder.

Patients can also feel full even though they only eat small portions. This can occur if the spleen is enlarged to press against the stomach, which is right next to the spleen. If the spleen enlarges to press on other organs, blood flow to the spleen can be obstructed so that spleen function is disrupted.

If it gets bigger, the spleen can filter more red blood cells so that the number of red blood cells in the blood decreases. This condition can cause symptoms of anemia, such as paleness and weakness.

In addition, infections will also often occur when the spleen does not produce the required amount of white blood cells.

Other symptoms that may appear are:

  • Fatigue
  • Easy to bleed
  • Weight loss
  • Jaundice

When to go to the doctor

An enlarged spleen is not always a sign of a serious condition. The spleen can enlarge if it is overactive in attracting and destroying red blood cells. This condition is known as hypersplenism.

Even so, the examination still needs to be done to determine the cause of splenomegaly. Immediately consult a doctor if you experience pain in the upper left abdomen, especially if the pain is very severe or gets worse when you take a deep breath.

Splenomegaly Diagnosis

The doctor will ask about your symptoms, followed by a physical examination to feel an enlarged spleen in the upper left abdomen. If necessary, the doctor will confirm the diagnosis by carrying out the following tests:

  • Blood tests, such as a complete blood count, to determine levels of red blood cells, white blood cells, and platelets
  • Ultrasound or CT scan of the abdomen, to determine the size of the spleen and see the condition of other organs that are depressed due to the size of the enlarged spleen
  • MRI, to see blood flow in the spleen
  • Bone marrow aspiration, to detect blood disorders that could be the cause of splenomegaly
  • Biopsy (tissue sampling) of the spleen, to detect possible lymphoma of the spleen

Splenomegaly Treatment

Treatment for splenomegaly is to treat the underlying cause. For example, your doctor may prescribe antibiotics to treat splenomegaly caused by a bacterial infection.

Splenomegaly is often asymptomatic and no cause is found. In patients who experience this condition, doctors need a longer evaluation time while monitoring the progress of the patient's condition.

Surgical removal of the spleen (splenectomy) can be performed in several conditions, for example:

  • The spleen is too big, its function has decreased, and it interferes with the work of other organs
  • The spleen is too big but the cause is unknown
  • The spleen is too large and the cause cannot be treated

Patients whose spleens have been removed can still function normally, but are more at risk of severe infection. The following steps can help reduce the risk of infection in patients who have had a splenectomy:

  • Taking antibiotics after surgery or if there is a possibility of infection
  • Be more careful when you have a fever, because this condition can be a sign of infection
  • Get vaccinations before and after spleen removal, including vaccines pneumococcal (given every 5 years after surgery), meningococcal, and Haemophilus influenzae type B, to prevent pneumonia, meningitis, and infections of the bones, joints, and blood
  • Avoid visiting areas where there are many cases of infection or areas with endemic diseases, such as malaria

Splenomegaly Complications

If not treated immediately, splenomegaly can cause the number of red blood cells, white blood cells, and platelets in the blood to decrease. As a result, infection and bleeding may occur more frequently or occur immediately to a severe degree.

In addition, the spleen is a soft organ. If it continues to enlarge, the spleen is prone to rupture or leak. This can trigger bleeding in the abdominal cavity which can lead to massive blood loss, hypovolemic shock, and even death.

Splenomegaly Prevention

Splenomegaly can be prevented by avoiding things that can trigger this disease, namely in the following ways:

  • Reduce consumption of alcoholic beverages to prevent cirrhosis
  • Get vaccinated if you want to travel to malaria endemic areas
  • Use seat belts when driving or body armor when exercising, to prevent injury to the spleen