Asplenia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 4, 2016
StartDiseasesAsplenia

The term, asplenia literally means 'absent spleen.' Characterized by a complete absence or severe malfunction of the spleen, there are many factors surrounding the onset, symptoms, and prognosis of this condition.

Contents

Definition & Facts

Weighing roughly 6 ounces, the spleen's function is to filter blood. Together with the lymph nodes, the spleen plays a large role in supporting a healthy immune system. This is why physicians will examine the left side of the abdomen for an enlarged spleen (splenomegaly) when a serious viral infection or bacterial infection is suspected, such as mononucleosis.

The spleen removes old, run-down, or abnormal red blood cells, stores new ones, and also produces lymphocytes, a type of white blood cell. These white blood cells fight off bacteria and infection. The spleen also stores platelets. Platelets are present in the blood and form clots to stop bleeding.

Conditions ranging from anemia, Celiac disease, or even cirrhosis where the spleen is working overtime could cause asplenia. Additionally, issues within the spleen itself may lead to a complete removal of the organ (splenectomy).

Symptoms & Complaints

Abdominal pain located on the upper left side of the body may be indicative of asplenia. In addition, the following problems may ensue as a result of asplenia:

  • Infection: A high risk of infection is regarded as the most critical potential issue arising from complications of asplenia. When the spleen is not working at its normal capacity, the body is much more susceptible to bacteria and infectious disease. Even more common illnesses such as pneumonia, strep throat, and influenza pose serious risks to those with diminished spleen function.
  • Organ displacement: Because of the positioning of the spleen amongst other internal organs, asplenia may cause the organs to shift. Any variation of the spleen's normal placement, or lack thereof, could cause problems with digestion. Oftentimes, patients will complain of feeling full after eating very little. The stomach may also become twisted and obstruct other organs in the process.
  • Heart conditions: Heart disease is common in children suffering from asplenia. Abnormal blood flow puts extra pressure on the heart which is particularly dangerous to infants and newborns.

Causes

The causes of asplenia are almost always symptomatic of other conditions. A primary illness will cause the spleen to be altered or have limited function. In turn, the body is then more susceptible to a variety of illnesses.

A splenectomy (surgical removal of the spleen) is sometimes necessary due to certain kinds of cancers or even an abscess in the spleen. Severe trauma, like bodily injury in a car accident or organ damage while playing contact sports, could also call for partial or total spleen removal. 

The spleen is soft and spongy, and while it is usually well protected by the rib cage, it is considerably more fragile when swollen. Chronic enlargement of the spleen may result in its complete removal as a last resort.

Many patients who have sickle-cell anemia also suffer from asplenia. With this condition, red blood cells that have ragged edges or are "sickled" (hence the name) get trapped in the spleen. This syndrome is much more serious in infants and children.

Lupus, like, sickle-cell anemia, will cause the spleen to deflate, shrivel, and stop all function. This process is referred to as autosplenectomy and is a condition in which the body itself causes the spleen to shrink or disappear. Heterotaxy syndrome is a birth defect where organs do not occupy their normal positions and prevent the spleen from functioning normally.

Diagnosis & Tests

To accurately diagnose asplenia, typically an ultrasound will be done to determine the flow of blood to the organ. To assess the position and condition of the internal organs, a magnetic resonance imaging (MRI) may also be performed. Additionally, an echocardiogram, i.e. a heart sonogram, will identify irregularities in blood flow to the heart. If there are problems in the lungs because of spleen malfunction, X-rays of the chest may also be conducted.

Various blood tests may be taken to detect the presence of specific "bodies" that result from red blood cell damage. For example, if Howell-Jolly bodies or Heinz bodies are found in erythrocytes, this could be indicative of spleen damage. A bone marrow biopsy may also be conducted to analyze any abnormalities in blood cells.

Treatment & Therapy

The spleen is an essential part of body function, but if it experiences complications or complete failure, other organs, namely the liver and lymph nodes, can take over its duties. It is crucial, however, to lower the risk of infections.

Vaccines are a way to address a weakened immune system brought on by asplenia. Since the body loses its ability to fight off infections as effectively, vaccines are a key part of managing the disorder. Antibiotics, sometimes taken daily, are another way to prevent potential infection.

Avoiding intense sports or jarring activities can help avoid further injury. As the body is generally weakened against serious disease, traveling to a new area or out of the country poses special risks. One should be cautious of certain areas when planning a travel itinerary.

Prevention & Prophylaxis

It is very possible to live a healthy life without a spleen. However, the condition does not come without its complications. While completely preventing asplenia is not possible, especially when hereditary, there are key measures that must be taken to manage the associated risks.

  • Wearing a medical alert bracelet is prudent for those with this condition. Also, carrying an up-to-date medical ID card at all times should something happen is also prudent.
  • If patients experience a high grade fever, they should contact a doctor immediately.
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