What are the other names for this Condition? (Also known as/Synonyms)

• Overactive Spleen

What is Hypersplenism? (Definition/Background Information)

• Hypersplenism is a condition when an individual has an Overactive Spleen. The spleen functions as a filter to remove old and injured cells from the bloodstream (such as old red blood cells that are not functioning well)
• Red blood cells (RBCs) are the principle ‘gas’ transport vehicles of the body. They supply tissues with oxygen and carry carbon dioxide away to the lungs, for excretion. RBCs have a maximum lifespan of 120 days
• An Overactive Spleen may have an unintended consequence such as removing the red blood cells from circulation before the RBCs have “aged”. Hypersplenism usually involves pancytopenia, which is a reduction in the number of circulating blood cells. Common signs and symptoms of the condition include fatigue and weakness on account of low blood cell count
• Hypersplenism can be caused by many factors, but it is usually caused by splenomegaly (an enlarged spleen) and certain blood disorders. One major risk factor for Hypersplenism is malarial infection
• The treatment of Hypersplenism is focused on treating the underlying cause, which could be infections, cirrhosis, or other diseases. It may involve blood transfusions and even surgery to remove the spleen, if needed, in severe cases
• The prognosis for Overactive Spleen depends on each individual case. If the underlying cause of Hypersplenism is treatable, then the outcomes are generally good

Who gets Hypersplenism? (Age and Sex Distribution)

• Individuals of all age groups, from young children to older adults, can be affected by Hypersplenism depending on the underlying cause
• Both males and females are affected, and no gender bias is noted
• Depending on the underlying cause, the condition can affect different racial and ethnic groups

For example, in the US, Hypersplenism caused by liver cirrhosis is more likely to affect African-Americans and Mexican-Americans than individuals of other races.

What are the Risk Factors for Hypersplenism? (Predisposing Factors)

Some risk factors of Hypersplenism include:

• Blood disorders such as anemia or sickle cell disease
• Inherited metabolic diseases such as Gaucher’s disease
• Individuals living or traveling to places where infections, such as malaria, is endemic

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Hypersplenism? (Etiology)

The following conditions are known to cause Hypersplenism:

• Hematological disorders, which are blood-related diseases and disorders (such as anemia). It is the most common cause of Hypersplenism
• Liver cirrhosis, which is scarring of the liver
• Bacterial infections such as tuberculosis
• Malaria
• Viral infections such as hepatitis and HIV infection
• Hematological malignancies such as lymphoma (a type of malignancy affecting the lymphatic system) and leukemia (a type of blood cancer of circulating white blood cells)
• Other malignancies such as sarcoma
• Metastasis (cancer spread) to the spleen
• Lipid storage disorders such as Gaucher’s disease and Niemann-Pick disease 

What are the Signs and Symptoms of Hypersplenism?

The common signs and symptoms of Hypersplenism can include:

• Splenomegaly or an enlarged spleen
• Feeling full after a small meal
• Discomfort and pain on the left side of the stomach
• Signs and symptoms related to anemia such as
  • Skin pallor
  • Muscle pain
  • Headache
  • Nausea and vomiting
  • Diarrhea
  • Fatigue and weakness
  • Shortness of breath
  • Rapid heartbeat
• Additionally, signs and symptoms of the underlying causative condition may be noted

How is Hypersplenism Diagnosed?

A diagnosis of Hypersplenism may involve the following exams and procedures: 

• A full medical history of the individual
• A complete physical examination including examination of the abdomen
• Complete blood count (CBC) test to look for abnormalities in blood cells. It can indicate a low blood cell count and low survival of red blood cells
• Ultrasound scan of the abdomen
• An X-ray or an MRI scan of the abdomen to visualize the spleen
• Appropriate tests to rule out conditions that result in Hypersplenism

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Hypersplenism?

If Hypersplenism is not treated promptly, then there may be complications such as:

• Frequent Infections, since increased destruction of white blood cells can decrease the immunity of the individual
• Severe anemia
• Severe bleeding due to decreased platelets
• Ruptured spleen: Since an enlarged spleen can easily be damaged, it is more likely to rupture causing major internal bleeding. This is a medical emergency
• Complications may also arise from the underlying cause of Hypersplenism

How is Hypersplenism Treated?

In many individuals, Hypersplenism may be mild. In such individuals, close observation with a wait and watch approach can be undertaken. The treatment is usually administered when the signs and symptoms are significant.

The treatment may involve:

• Treating the underlying cause: The underlying condition that causes Hypersplenism is targeted for treatment
• Treating the enlarged spleen

The treatment measures for Hypersplenism may include:

• Blood transfusions
• Use of radiation therapy to reduce/shrink the spleen size. Reduction of the spleen size may help the spleen from being overactive
• Surgery: Performing a splenectomy (removal of the spleen)
• Vaccination for individuals who have had a splenectomy, in order to prevent further (future) infections
• Prophylactic antibiotics may be recommended for individuals who have undergone splenectomy

How can Hypersplenism be Prevented?

Presently, there are no method available to prevent Hypersplenism. Nevertheless, the following factors may be considered:

• Undertaking proper treatment of underlying infections, conditions, and malignancies that may cause Hypersplenism
• Avoiding excessive drinking of alcohol can help prevent liver cirrhosis that results in Hypersplenism

What is the Prognosis of Hypersplenism? (Outcomes/Resolutions)

• The prognosis for individuals with Hypersplenism is usually good; however, it also depends on the underlying cause of the condition
• If the underlying disease/disorder is easily treatable, then Hypersplenism can be easily managed
• Individuals who have had their spleens removed, are at an increased risk for infections in the future. Hence close follow-ups and pneumococcal vaccinations are recommended

Additional Relevant Useful Information for Hypersplenism:

Individuals with Hypersplenism or splenomegaly must be careful while performing any physical activity that places pressure on the left side of the torso. Restricting these activities can help ensure that there is a low risk of splenic rupture and consequent uncontrolled hemorrhage.