Spleen Disorders - Diagnosis and Treatment

Introduction

The spleen is an important organ forming a part of the reticuloendothelial and hematological systems. Spleen is situated in the left rib cage, behind the 9th and 11th ribs, in the upper segment of the abdomen. It is located in the peritoneal cavity at the back and lateral to the stomach.

What Is the Structure of the Spleen?

The spleen consists of two parts: the white pulp and the red pulp.

White pulp: The white part has lymphoid aggregates (collection of lymphoid tissue), which include lymphocytes and macrophages. There are two types of lymphocytes present, namely B-lymphocytes and T-lymphocytes. These are immune cells that protect the body from infection. These cells surround the splenic arteries.

Red pulp: The red pulp is composed of connective tissue formed into splenic cords called cords of Billroth, and in between these cords, splenic sinusoids are present. The splenic sinusoids are cavities filled with blood, thus giving a red color appearance. Their function is to purify the blood by filtering antigens, damaged or worn-out erythrocytes, and microbes.

The spleen has various functions, which are listed below.

• Produces antibodies to fight against infections.

• Reserves blood.

• Purifies the bloodstream by removing damaged and old cells and other waste products of cells.

• Balances the fluid levels of the body.

What Are the Disorders That Affect the Spleen?

There are several diseases that affect the spleen, which includes:

• Splenomegaly: Splenomegaly means enlargement of the spleen. The spleen can grow bigger in size due to various reasons, which can make it weigh around two kilograms or more. The enlargement happens in response to the rapid degradation of red blood cells (in blood diseases like hemolytic anemia) due to the workload of the spleen to remove the ruptured blood cells. There might be other conditions of spleen enlargement like

  • Infections such as glandular fever, malaria, syphilis, endocarditis, and mononucleosis.

  • Blood cancers (Hodgkin's disease, lymphoma, leukemia) and metastasis from other organs to the spleen.

  • Liver diseases, for example, liver cirrhosis.

  • Anemias like hemolytic anemia.

  • Formation of blood clots in the spleen.

  • Inflammatory diseases like sarcoidosis.

  • Genetic metabolic disorders include Gaucher disease.

  • Cystic fibrosis.

  • Protein metabolism defects like amyloidosis.

  • The signs and symptoms of splenomegaly are:

    • Pain in the upper left abdomen that radiates to the shoulder.

    • A feeling of fullness in the belly without eating or eating less quantity of food.

    • Frequent infections.

    • Bleeding tendency.

    • Anemia.

• Splenic Rupture: In some conditions, the underlying cause of spleen enlargement can make the spleen fragile and increase the tendency to rupture spontaneously. The outer covering of the spleen, called the capsule, can break with a sudden blow to the abdomen, leading to bleeding into the abdominal cavity. Splenic rupture can be of different degrees. Splenectomy (removal of the spleen) is the choice of treatment during severe bleeding. The other causes of splenic rupture can be trauma due to road accidents and blow to the abdomen during fights, domestic violence, and sports. The signs and symptoms of a splenic rupture are:

  • Nausea.

  • Dizziness/light-headedness.

  • Confusion.

  • Fainting.

  • Blurred vision.

  • Anxiety.

  • Restlessness.

  • Paleness.

  • Pain on the left shoulder.

  • Pain in the upper left side of the abdomen, under the ribs.

• Hypersplenism: It is a combination of two conditions of splenomegaly (enlargement of the spleen) and deficiency of one or more blood components, that is, either red blood cells, white blood cells, or platelets. The reason is that an enlarged spleen is excessively active and destroys more than the required quantity of blood cells, leading to its deficiency. The most common causes of hypersplenism are the condition that causes splenomegaly. A few examples are:

  • Liver cirrhosis.

  • Infections like malaria and tuberculosis.

  • Lymphoma.

  • Inflammatory diseases.

  • Connective tissue diseases.

  • The signs and symptoms include:

    • Anemia - Reduced red blood cells having symptoms of anemia like cold hands and feet, tiredness, shortness of breath, irregular heartbeat, dizziness, and pale skin.

    • Leukopenia - Reduced white blood cells leading to increased susceptibility to infections.

    • Thrombocytopenia - Reduced platelet count leading to an increased tendency to bleed easily, frequent bruising, prolonged bleeding from wounds and cuts, blood in urine or stools, and bleeding from nose and gums.

• Functional Asplenia: It is defined as a complete loss of function of the spleen. The spleen does not function properly to filter the antigens in the blood but retains the structure of tissues. The main causes are due to some medical conditions like:

  • Auto-immune disease.

  • Celiac disease.

  • Sickle-cell disease.

  • Inflammatory bowel syndrome.

  • Nephrotic syndrome.

  • Beta-thalassemia.

  • Severe HIV infection.

How Is Spleen Health Checked?

Spleen health and any related disorder can be checked through many tests.

Clinical evaluation: The spleen is checked by palpation and percussion. Palpation means using hands to touch and feel an organ. The spleen is palpated to check if it is enlarged to diagnose splenomegaly. Normally the spleen is not palpable, but if it becomes larger in size, it can be palpated. Palpation can be done in different methods like classic (one-hand technique), bimanual (two-hand technique), hooking, and dipping methods. Percussion means gently tapping the skin over an organ with an instrument to identify an abnormality. There are various percussion methods, like Castell's, Nixon's, and Traube's semilunar space.

• Blood Tests: Complete red and white blood cell count and platelet count are measured to assess the proper functioning of the spleen.

• Ultrasound: This imaging technique uses sound waves to determine the organ's size and its relationship with the surrounding organs in case of splenomegaly.

• Computed Tomography (CT) Scan: This scan uses a series of X-rays taken from different angles to study the size of the spleen and other organs.

• Magnetic Resonance Imaging (MRI): The imaging technique uses magnetic waves to assess the blood flow to the spleen.

• Bone Marrow Biopsy: A sample solid of bone marrow is taken, and its microscopic structure is studied. This can determine the cause of the enlargement in splenomegaly.

How Are Spleen Disorders Treated?

The treatment of a spleen disorder depends on the underlying cause. The primary cause of spleen disorder is treated first, which usually improves splenic health. For example, if the cause is cancer, like leukemia, the treatment involves treating cancer with chemotherapy or radiotherapy. Splenectomy (surgical removal of the spleen) is the choice of treatment when the spleen has been severely damaged and bleeding. The spleen can be removed either completely or partially. Living without a spleen is possible, except the body will be more prone to infections. So, appropriate lifestyle modifications, practice hygiene, and diet changes to help the body fight against infection have to be done. In addition, the patients are recommended to take pneumococcal vaccines to prevent infections.

Conclusion

The body can survive without a spleen, although it has some significant functions. The liver takes over the functions of the spleen. In rare cases, some babies are born without a spleen called asplenia. Such individuals should be more careful about getting an infection. In case of any symptoms associated with spleen disorders, it is advisable to consult a physician immediately to prevent any further complications and ease the treatment plan.