Enlarged Spleen โ Diagnosis and Treatment
Diagnosis
Doctors identify an enlarged spleen (splenomegaly) step by step. They start with a physical exam and use different tests.
They look for signs like belly pain, fatigue, anemia, easy bruising, or frequent infections. The spleen is part of the lymphatic system and helps filter blood.
Changes in blood cell counts or spleen size can give important clues. During a physical exam, the doctor gently presses on the upper left side of the belly to feel if the spleen is larger than normal.
A healthy spleen is usually not felt easily. In some people, especially those who are thin, even a normal spleen may be noticeable.
Doctors confirm splenomegaly with these tests:
- Blood tests: Doctors check for changes in red blood cells, white blood cells, and platelets. This helps them find anemia, leukopenia, thrombocytopenia, and other blood problems.
- Imaging: Ultrasound, CT scan, or MRI shows the exact size of the spleen and whether it puts pressure on other organs.
- Liver Function Tests: These tests help find out if liver disease, such as cirrhosis, is causing the problem.
Doctors also ask about medical history and symptoms. They want to know if you have fever, bruising, night sweats, infections, or feel full quickly after eating.
Figuring Out the Underlying Reason
To find the cause of spleen enlargement, doctors may order more tests. These can include:
- Bone Marrow Exams: Doctors take a sample of bone marrow, usually from the hip bone, using a needle. They use this test to look for blood cancers such as leukemia or lymphoma, or problems like Gaucher disease.
- Other Special Tests: If infections like malaria or parasites are suspected, doctors order blood tests to look for these germs.
- Spleen Surgery (Splenectomy): In rare cases, when no cause is found, doctors may remove the spleen. They examine the spleen under a microscope for signs of lymphoma or other cancers.
Doctors use these tests to check for more than just infections. They look for autoimmune conditions, blood disorders such as sickle cell disease, metabolic problems like Niemann-Pick disease, and risk factors like lupus or a family history of blood diseases.
Doctors rarely use a needle biopsy of the spleen because it can cause bleeding. They always balance the need for a diagnosis with the patientโs safety.
Treatment
Monitoring Without Immediate Treatment
Doctors may suggest regular checkups if you have an enlarged spleen but no symptoms or a clear cause. This means you visit for routine exams every 6 to 12 months or sooner if symptoms appear.
The main goal is to watch for any changes. If complications or new symptoms develop, doctors will change the plan.
Surgery to Remove the Spleen
If the spleen causes serious issues or no effective treatment is available, doctors may recommend a splenectomy. In this surgery, doctors remove the spleen.
It is important to weigh the risks and benefits. People can live without a spleen, but it helps fight germs and prevent infections.
After a splenectomy, the risk of severe or frequent infections goes up. If the spleen ruptures, doctors may need to do surgery right away.
Possible reasons for spleen removal:
- Ongoing complications from an enlarged spleen
- High risk of the spleen rupturing
- Other treatments have not worked
Lowering the Chances of Infection After Surgery
After a splenectomy, preventing infection is very important. Doctors recommend these steps:
- Get a series of vaccines before and after spleen removal. These include shots for Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b. Boosters, like the pneumococcal vaccine, are needed every five years.
- Take daily antibiotics, such as penicillin, and start them quickly if an infection is suspected.
- Report any fever or illness to a healthcare provider right away.
- Avoid areas with diseases like malaria.
These steps help lower infection risk and support long-term health after spleen removal.
Healthy Habits and At-Home Tips
Avoid activities that could cause injury. Stay away from contact sports like soccer, football, and hockey because they can damage the spleen.
Always wear a seat belt when you drive or ride in a vehicle. This helps protect you from injury. Stay up to date with vaccines to lower your risk of infections. Get routine shots like the flu vaccine every year.
Get boosters such as Tdap every 10 years. Ask your healthcare provider if your immunizations are current.
