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Hypersplenism - Types, Symptoms, and Treatment

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Hypersplenism is the increased activity of the spleen leading to the loss of blood cells. The article explains the condition and the treatment.

Medically reviewed by

Dr. Ghulam Fareed

Published At December 27, 2022
Reviewed AtJuly 3, 2023

Introduction:

The phenomenon of having an overactive spleen is known as hypersplenism. In this situation, the spleen removes too many blood cells during filtration, including the healthy ones. Due to this loss of healthy blood cells, it becomes difficult for the body to fight any infections, and there might be anemia.

Anemia is a condition in which there is a decreased amount of red blood cells in the blood, leading to reduced oxygen. This hyperactive feature of the spleen also leads to the loss of white blood cells, which are very important for the lymphatic and immune systems. Hypersplenism can be of two types, mainly primary and secondary hypersplenism. The condition can be characterized by enlargement of the spleen, reduced levels of red blood cells, and a feeling of fullness even after eating very less.

What Is a Spleen?

A spleen is a fist-sized organ located on the side of the lower ribs behind the stomach. It is known to have important functions, which include storage and filtration of the blood. It helps to remove old and damaged blood cells from the bloodstream. Spleen also helps to produce antibodies which help the body to fight any infection and strengthen the immune system. It also helps to maintain the levels of fluids in the body.

What Are the Types of Hypersplenism?

  • Primary Hypersplenism: This hyperactivity of the spleen is induced within the spleen itself, and no external factor is involved in it.

  • Secondary Hypersplenism: It is caused by various other diseases, such as chronic liver diseases, infections, or autoimmune diseases.

What Are the Causes of Hypersplenism?

Any disorder that can cause spleen enlargement (splenomegaly) can lead to hypersplenism. When the spleen is enlarged, it stores more blood cells, including healthy ones. Due to this storage, healthy blood cells cannot circulate in the body, thus leading to compromised body functions and an immune system. Some of the conditions which can lead to hypersplenism are:

  • Chronic Liver Diseases: It includes hepatitis C infection, which leads to inflammation and cirrhosis of the liver. Cirrhosis which is caused by overconsumption of alcohol and also the nonalcoholic causes leads to hypersplenism.

  • Autoimmune Diseases: Lupus erythematosus and rheumatoid arthritis can cause inflammation.

  • Infections: Flu infections such as malaria and bacterial lung disease such as tuberculosis can lead to hypersplenism.

  • Gaucher Disease: It is a genetically inherited disorder that leads to fat accumulation fat in the spleen.

  • Cancer: Lymphoma is a malignancy of the lymphatic system that can lead to the spleen's enlargement.

What Are the Symptoms Seen in Hypersplenism?

There are some signs which indicate enlargement of the spleen or hyperactivity, such as:

  • Feeling full even after eating a very small amount of food. This is also known as abnormal fullness.

  • Increased size of spleen leading to pain and fullness on the left side of the upper chest area. It is also easy to palpate for the doctor.

  • A decrease in the number of red blood cells in the blood is known as cytopenia.

  • The decreased potential of the body to fight infections due to reduced blood cells leads to compromised immunity.

  • It also leads to anemia. Reduced red blood cells lead to reduced hemoglobin and, thus, reduced oxygen in the blood. The symptoms include headache, weakness, cold intolerance, and shortness of breath.

How to Diagnose Hypersplenism?

The diagnosis of hypersplenism is made depending on the following factors:

  • Physical examination involving palpations of the left side of the chest to see for an enlarged spleen.

  • Blood tests will help to evaluate the amount of red and white blood cells in the body.

  • Imaging tests such as endoscopy and ultrasound will help to see the status of the spleen inside the abdomen.

  • Investigation for any other underlying disease history which may cause hypersplenism.

What Is the Treatment for Hypersplenism?

  • The most important way of treating hypersplenism is treating the underlying cause, which leads to hyperactivity.

  • In cases of liver cirrhosis, it is advised to change the diet, which includes quitting alcohol consumption and diuretics intake, which may help flush out the increased amount of fluids in the body. Hepatitis C should also be treated with antiviral medications prescribed by the doctor.

  • Tuberculosis should be diagnosed and treated with antibacterial drugs known as antibiotics.

  • In some cases of splenomegaly, it is advised to undergo spleen shrinkage with the help of radiation. Studies have proposed that low-dose radiation helps reduce the spleen's size in almost 78 % of the participants.

  • In cases of severe splenomegaly, the process of laparoscopy is recommended to remove the spleen. In this technique, an instrument with light is passed through small incisions, and the spleen is removed. It is a minimally invasive surgical technique. It is the most recommended process of splenectomy as it leads to decreased blood flow and shorter hospital admissions.

What Complications Happen After Removal of Spleen?

As stated spleen helps in the filtration of the blood cells and helps in the formation of antibodies. Thus it plays an important role in the immune system. The body becomes susceptible to infections and microorganisms when the spleen is removed. Any infection easily affects the body and leads to further complications. Thus it is important to take preventive measures to be safe after splenectomy as the immune system is weak.

Conclusion:

Hypersplenism is the increased activity of the spleen involving enlargement of the spleen. The spleen cannot differentiate between damaged and good cells during filtration and excrete out the healthy ones too. This leads to decreased blood cells in the body, which further causes compromised immunity and anemia. The causes of hypersplenism can be many diseases, such as hepatitis C, rheumatoid arthritis, and infections like tuberculosis or Gaucher disease. The symptoms include weakness, headache, and shortness of breath. The treatment of the disease is dependent on the underlying cause. However, some severe cases may require radiation shrinkage or splenectomy.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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