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Hypersplenism – Causes, Symptoms and Treatment

Hypersplenism refers to an overactive spleen that excessively destroys blood cells, leading to anemia, increased bleeding risk, or greater susceptibility to infections.

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Things worth knowing about "Hypersplenism"

Hypersplenism refers to an overactive spleen that excessively destroys blood cells, leading to anemia, increased bleeding risk, or greater susceptibility to infections.

What is Hypersplenism?

Hypersplenism is a condition in which the spleen becomes overactive and destroys blood cells at an abnormally high rate. The spleen is an organ located in the upper left abdomen that normally filters old or damaged blood cells and supports the immune system. In hypersplenism, this filtering function becomes excessive, causing the premature destruction of healthy blood cells. This results in a deficiency of red blood cells (anemia), white blood cells (leukopenia), and platelets (thrombocytopenia), a combination often referred to as pancytopenia.

Causes

Hypersplenism is typically not a primary disease but rather a consequence of an underlying condition. The most common causes include:

Liver cirrhosis with portal hypertension (elevated pressure in the portal vein)
Chronic liver diseases such as hepatitis B and C
Splenomegaly (enlarged spleen) of various origins
Hematological diseases such as lymphomas, leukemias, or Gaucher disease
Infectious diseases such as malaria, leishmaniasis, or infectious mononucleosis
Autoimmune diseases such as systemic lupus erythematosus (SLE)
Heart failure or portal vein thrombosis

Symptoms

Symptoms of hypersplenism are mainly caused by low blood cell counts and an enlarged spleen:

Fatigue and exhaustion due to anemia
Increased tendency to bleed due to low platelet counts (thrombocytopenia)
Frequent infections due to low white blood cell counts (leukopenia)
Pressure or pain in the upper left abdomen due to splenomegaly
Early satiety, as the enlarged spleen presses against the stomach
Pallor, dizziness, and shortness of breath as symptoms of anemia

Diagnosis

The diagnosis of hypersplenism is established through a combination of clinical examination, laboratory tests, and imaging:

Complete blood count (CBC): Detection of anemia, leukopenia, and/or thrombocytopenia
Abdominal ultrasound: Assessment of spleen size and liver changes
CT or MRI: Detailed imaging to identify the underlying cause
Bone marrow biopsy: To rule out bone marrow disorders as the cause of cytopenia
Liver biopsy or liver enzyme tests: When liver disease is suspected

Treatment

Treatment of hypersplenism is primarily directed at the underlying cause:

Treatment of the Underlying Condition

Addressing the root cause is always the primary goal. In cases of portal hypertension due to liver cirrhosis, for example, beta-blockers or endoscopic procedures can reduce portal vein pressure, thereby decreasing splenic overactivity.

Medical Therapy

Depending on the cause, medications such as corticosteroids for autoimmune conditions or specific treatments for infectious diseases may be used.

Surgical Removal of the Spleen (Splenectomy)

In severe cases where conservative treatment is insufficient, a splenectomy (surgical removal of the spleen) may be considered. However, following splenectomy, patients face a significantly increased risk of serious infections. Therefore, vaccinations against pneumococci, meningococci, and Haemophilus influenzae are strongly recommended before the procedure.

Partial Splenic Embolization

As a less invasive alternative to splenectomy, partial embolization of the splenic arteries can be performed to reduce splenic function and alleviate symptoms.

Prognosis

The prognosis of hypersplenism depends largely on the underlying cause. If the root condition is successfully treated, splenic function may normalize. In chronic diseases such as liver cirrhosis, long-term management is typically required.

References

Kasper, D. L. et al. - Harrison's Principles of Internal Medicine. McGraw-Hill Education, 20th edition (2018).
Feldman, M. et al. - Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Elsevier, 11th edition (2021).
World Health Organization (WHO) - Guidelines for the treatment of malaria and associated splenomegaly. WHO Press, Geneva (2022).

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