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Splenectomy

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What Is Hypersplenism?

The spleen is an organ in the abdomen (belly), just under the left ribs. It’s 5 inches by 3 inches, about the size of a fist. It fights infections and filters blood to get rid of cell debris. Different diseases can cause an enlarged spleen (splenomegaly). These include leukemia, lymphoma, metastatic tumors (cancers that spread), infections, liver cirrhosis, and congestive heart failure. Infections that may cause an enlarged spleen are viral hepatitis, mononucleosis, HIV, malaria, and endocarditis (a heart infection).

Hypersplenism is a syndrome that involves splenomegaly plus destruction of blood cells. Destruction of red blood cells causes anemia. Destruction of white blood cells causes leukopenia (low white blood cell count). Destruction of platelets causes thrombocytopenia (low platelet count).

What Causes Hypersplenism?

Hypersplenism is generally due to liver disease (cirrhosis), blood cancers, connective tissue and inflammatory diseases, and infections (tuberculosis, malaria).

What Are the Symptoms of Hypersplenism?

Symptoms include early satiety (feeling full after eating only very little), pain in the left upper part of the abdomen due to a large spleen, and feeling bloated. Easy bruising and bleeding and getting frequent and severe bacterial infections may be other manifestations of hypersplenism. Fever, weakness, heart palpitations, and ulcers of the mouth, legs, and feet can occur.

How Is Hypersplenism Diagnosed?

The health care provider makes a diagnosis from the medical history, physical examination, blood tests, and imaging studies. These studies may include ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI). If suspecting hypersplenism, the health care provider may in some cases refer you to a hematologist to do a bone marrow biopsy to help determine the cause of the hypersplenism. A hematologist is a specialist in blood diseases. In the biopsy, the health care provider uses a needle to take a sample of bone marrow tissue to check with a microscope.

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How Is Hypersplenism Treated?

Untreated hypersplenism can lead to serious complications. The cause must be identified and treated. For example, chemotherapy is used for cancers. Antibiotics are used for bacterial infections (e.g., Lyme disease and bacterial endocarditis). Antiparasitic drugs are used for parasitic infections (e.g., schistosomiasis and malaria). Surgery to remove the spleen (splenectomy) may be done for people whose diagnosis cannot be made or people who have lasting symptoms even with treatment. A splenectomy may fix the low blood cell counts commonly seen in people with hypersplenism.

DOs and DON’Ts in Managing Hypersplenism:
  • DO realize that people can live without a spleen, even though it helps fight infections and removes cell debris.
  • DO remember that people who have their spleens removed are more likely to get serious infections caused by bacteria such as pneumococci and Haemophilus influenzae. Vaccinations can help protect against these infections and should be administered before the spleen is removed.
  • DO call your health care provider if you have abdominal pain, long-standing abdominal bloating, an alcohol problem, or a drug problem.
  • DON’T forget that the prognosis depends on the cause of hypersplenism. For example, parasitic infections such as malaria, toxoplasmosis, and leishmaniasis can be treated. Metastatic cancer, however, may not have a cure.
  • DON’T drink alcohol. Long-term use can damage your liver and lead to splenomegaly.
  • DON’T do drugs. Intravenous drug use places you at high risk for viral hepatitis and HIV. Both of these can lead to hypersplenism.
FOR MORE INFORMATION

Contact the following sources:

  • National Digestive Diseases Information Clearinghouse
    Phone:1-800-891-5389 or 1-301-654-3810
    Web: www.niddk.nih.gov/health/digest/nddic.htm
  • American Liver Foundation
    Tel: 800-465-4837
    Web: www.liverfoundation.org

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

Ferri’s Netter Patient Advisor