Hypersplenism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 7, 2016
StartDiseasesHypersplenism

Hypersplenism is a condition where the spleen filters out not only the old and damaged cells from the bloodstream but also the healthy ones too. This can lead to a variety of problems including low blood cell counts and infections.

Contents

Definition & Facts

Hypersplenism is a condition in which the spleen, a small organ usually located in the upper left quadrant of the human abdomen is overactive. The normal function of the spleen is to help filter old and damaged blood cells from the bloodstream. An overactive spleen can remove cells too quickly, and thus many healthy cells are filtered out. Among other problems, this can cause a person to be more susceptible to infections.

Hypersplenism should not be confused with splenomegaly, which is an enlargement of the spleen. While both conditions can occur together, they can occur separately as well.

Symptoms & Complaints

The symptoms of hypersplenism can be difficult to discern from other conditions, and many are not obvious. For example, the rapid destruction of healthy cells is the number one sign that a person has hypersplenism, and this may be apparent only from laboratory blood tests.

These blood tests will likely show low levels of certain types of blood cells, and the conclusion can be drawn that cells are being destroyed too rapidly. Lab testing often reveals a low white cell count and anemia, which is a low red blood cell count.

In addition, patients with hypersplenism are prone to bruising easily, often with little or no cause, and excessive bleeding, especially from mucous membranes. Mouth ulcers also tend to be a problem with people who have this condition. Moreover, symptoms can include heart palpitations, fever, and weakness. A person may feel an overall malaise, or feeling that they just are not well.

Some cases of hypersplenism also involve an enlarged spleen, but this does not always occur. When it does, patients are more likely to experience some pain on the upper left side of the abdomen and a feeling of fullness even after eating only small amounts. Many people notice that they are getting more infections than is common and this is often the reason they actually go to the doctor.

Causes

The cause of hypersplenism is not always known. Some cases appear to be hereditary and occur in several family members. There are also some conditions which are known to lead to the condition if not treated. For example, cirrhosis of the liver is an advanced liver disease that often leads to hypersplenism. Cirrhosis of the liver can be caused by drinking too much alcohol, by hepatitis, or other diseases.

In addition, cancers such as lymphoma and leukemia are commonly seen concurrently in a person who has developed hypersplenism. Other reasons that people get this condition can include diseases such as malaria and tuberculosis. Those that have certain connective tissue conditions or inflammatory diseases are in a higher risk category for having this condition of the spleen.

Diagnosis & Tests

When any symptoms are noticed, the first step for an individual is to visit a doctor. The doctor will likely start by asking questions about the patient's medical history in order to get a background on diseases the patient may already have or those that may be common in his or her family.

In addition, a complete physical examination will be necessary. If the spleen is also enlarged, the doctor will likely be able to feel it in the abdomen. Since the spleen can only be felt through the skin if it is enlarged, and this is not always the case with hypersplenism, it may yield no further information if it is of normal size. Either way, it is possible that there may be pain when the doctor presses on the area where the spleen normally is found. This is another clue that one may have the condition.

Nonetheless, laboratory blood tests can be ordered to help confirm any suspected diagnosis. The blood can be tested to determine the total blood cell count as well as the number of red and white blood cells present in the sample. If the numbers are low, this can indicate that the body is destroying blood cells too quickly.

In addition, specific infections can be tested for as well which is important since infection tends to occur more frequently in patients with this condition. Imaging tests such as ultrasonography or computed tomography (CT) scans may also be performed to get a picture of the spleen, which may assist in arriving at a definitive diagnosis.

Treatment & Therapy

Treatment of hypersplenism first requires that the cause of the illness be identified. If the cause is known, then the underlying cause must be treated, and the hypersplenism will also go away as a result.

In the meantime, management of the condition may require blood transfusions. These will help the patient to feel more energy and less weakness since the blood cells will be able to carry needed oxygen around the body. Infusions of healthy blood may need to be done more than once to get the levels properly adjusted.

In some cases, it may be necessary to simply remove the spleen. A splenectomy will occur if the patient has certain types of the conditions such as a hereditary hypersplenism with no other known causes. Also, in some cases of lymphoma, a splenectomy will also be performed. A person can function without a spleen though they do need to take extra care when exposed to infection.

Vaccinations may be especially crucial for individuals who have had their spleens removed in order to prevent infections.

Prevention & Prophylaxis

Prevention of hypersplenism is only possible insofar as it is possible to prevent other conditions. For example, those who have cirrhosis of the liver due to excess alcohol consumption need to control the amount of alcohol they drink to prevent the cirrhosis in the first place.

Diseases like malaria may be preventable by vaccination or avoiding areas known for high malaria incidences. Otherwise, having a healthy lifestyle can reduce one's risk of having hypersplenism.