Enlarged Spleen (Splenomegaly)

Diagnosis

An enlarged spleen is often detected during a physical examination. A healthcare provider can sometimes feel the spleen by gently pressing on the left upper part of the abdomen. In some cases, especially in slender individuals, a healthy spleen may also be palpable.

To confirm the diagnosis of an enlarged spleen, the following tests may be recommended:

• Blood tests such as a complete blood count (CBC) to check the number of red blood cells, white blood cells, and platelets, as well as liver function

• Ultrasound or CT scan to determine the spleen’s size and whether it is pressing against nearby organs

• MRI to assess blood flow through the spleen

Finding the cause

Additional testing may be necessary to identify the underlying cause of an enlarged spleen. This can include a bone marrow biopsy or aspiration.

• Bone marrow biopsy involves removing a small sample of solid bone marrow, usually from the pelvis.

• Bone marrow aspiration removes the liquid portion of the marrow. Both procedures can be performed at the same time.

Before either procedure, a general or local anesthetic is given to reduce discomfort. Needle biopsy of the spleen is rarely performed because of the risk of bleeding.

In some cases, when the cause of the enlargement cannot be determined, a splenectomy (surgical removal of the spleen) may be recommended for diagnostic purposes. The removed spleen is then examined under a microscope to check for possible lymphoma or other conditions.

Treatment

Treatment for an enlarged spleen depends on the underlying cause. For example, if a bacterial infection is the cause, antibiotics are prescribed.

Watchful waiting

If the enlarged spleen does not cause symptoms and the exact cause cannot be found, a watchful waiting approach may be advised. In this case, regular checkups every 6 to 12 months are recommended, or sooner if symptoms appear.

Spleen removal surgery

If the enlarged spleen leads to serious complications or the cause cannot be identified or treated, spleen removal surgery (splenectomy) may be considered. In chronic or severe cases, this may offer the best chance of recovery.

Although it is possible to live without a spleen, individuals are at higher risk of serious infections after the surgery.

Reducing infection risk after surgery

After spleen removal, certain preventive measures help reduce infection risk:

• Getting a series of vaccinations before and after surgery, including pneumococcal (Pneumovax 23), meningococcal, and Haemophilus influenzae type b (Hib) vaccines

• Receiving the pneumococcal vaccine every five years after surgery

• Taking antibiotics such as penicillin after surgery and during any suspected infection

• Contacting a doctor immediately if a fever develops

• Avoiding travel to regions where infections like malaria are common