SYMPTOMS

What are the manifestations of splenomegaly?

• Mild to moderate splenomegaly is usually asymptomatic.
• Significant enlargement to the level of the umbilicus or beyond often causes abdominal discomfort, such as mild bloating, pain, and reduced appetite.
• Severe splenomegaly with splenic infarction or perisplenic inflammation may lead to intense pain in the left upper abdomen or lower left chest, which worsens with breathing, along with localized tenderness or a friction sensation.

At what age can splenomegaly occur?

Splenomegaly can occur at any age.

How is the degree of splenomegaly determined?

Splenomegaly can be classified into mild, moderate, and severe degrees.

• Mild splenomegaly: The lower edge of the spleen extends 2 cm below the costal margin during deep inspiration.
• Moderate splenomegaly: The lower edge extends more than 2 cm below the costal margin but does not reach the umbilical level.
• Severe splenomegaly: The lower edge extends below the umbilical level.

What is the relationship between splenomegaly and hypersplenism?

Hypersplenism includes splenomegaly, but splenomegaly does not necessarily mean hypersplenism.

The main diagnostic criteria for hypersplenism include the following four items:

• Splenomegaly.
• Reduction in one or more of the following: red blood cells, white blood cells, or platelets.
• Hyperplastic bone marrow.
• Blood cell counts improve or normalize after splenectomy.
• ⁵¹Cr labeling can indicate excessive destruction or retention of red blood cells or platelets in the spleen.

TREATMENT

What are the methods to alleviate splenomegaly?

Splenomegaly is merely a symptom. Interventions (treatments) for splenomegaly should focus on addressing its underlying causes, such as:

• Methods to alleviate splenomegaly caused by hepatobiliary system diseases:
  Treat the hepatobiliary system diseases.

• Methods to alleviate splenomegaly caused by spleen diseases:
  For splenomegaly due to infection, administer anti-infection treatment or drainage.
  For splenomegaly caused by tumors, surgical treatment, radiotherapy, or chemotherapy may be applied.

• Methods to alleviate splenomegaly caused by chronic myeloid leukemia:
  Treatment with tyrosine kinase inhibitor targeted drugs (e.g., imatinib, dasatinib) can reduce spleen size.

• Methods to alleviate splenomegaly caused by primary or secondary myelofibrosis:
  Treatment with the selective JAK1 and JAK2 inhibitor ruxolitinib can improve splenomegaly.

• Methods to alleviate splenomegaly caused by connective tissue diseases:
  Treatment with glucocorticoids or combined immunosuppressants for the underlying disease can improve splenomegaly.

Why does splenectomy affect immune function in cases of splenomegaly?

The spleen is involved in the production of immune substances such as immunoglobulins and complements, so it is closely related to immune function. For non-emergency cases (e.g., hereditary spherocytosis), it is recommended to delay splenectomy until the immune system is relatively mature to reduce infection risks.

What lifestyle adjustments can help alleviate splenomegaly?

For individuals with splenomegaly, the most crucial step is to follow medical advice and receive targeted treatment. Patients should maintain healthy dietary and lifestyle habits, such as:

• Eat a light diet with plenty of vegetables and fruits, avoid overly greasy or cold foods.
• Maintain regular meals, rest adequately, and balance work with rest.
• Stay warm, ensure good ventilation, and avoid abdominal cold exposure.

Additionally, avoid injuries or falls, reduce strenuous activities, and seek immediate medical attention for bleeding by applying pressure to stop it.

If these measures fail to alleviate splenomegaly or if the condition worsens, seek medical attention promptly for further diagnosis.

DIAGNOSIS

What symptoms in patients with splenomegaly require medical attention?

• Splenomegaly accompanied by anemia, swollen lymph nodes, bleeding due to thrombocytopenia, fatigue, or night sweats—recommend visiting hematology.
• Splenomegaly accompanied by liver disease facies (darkened, dry, rough skin due to liver disease), loss of appetite, nausea, postprandial bloating, yellowing of the sclera, or dark urine—recommend visiting gastroenterology.
• Splenomegaly accompanied by various types of rashes, fever, or diarrhea—recommend visiting infectious diseases.
• Splenomegaly accompanied by edema—recommend visiting gastroenterology or infectious diseases.
• Splenomegaly accompanied by cardiomegaly, palpitations, or chest tightness—recommend visiting cardiology.

POTENTIAL DISEASES

What diseases may cause splenomegaly?

• The spleen is a hematopoietic tissue besides bone marrow, so hematologic diseases often involve the spleen. When bone marrow hematopoiesis is impaired, the spleen can compensate by producing blood cells, leading to splenic hyperplasia and enlargement. Additionally, malignant hematologic diseases may stimulate monocyte-macrophage system proliferation or directly invade the spleen, resulting in splenomegaly.
• Microbial and parasitic infections, as well as autoimmune diseases (e.g., rheumatoid arthritis, systemic lupus erythematosus), trigger immune responses. Since the spleen produces some of the antibodies generated by the body, antigen stimulation can enlarge germinal centers (located in the central part of splenic lymphoid nodules) and enhance phagocytic function, leading to splenomegaly.
• Portal hypertension (elevated pressure in the portal venous system) can obstruct splenic venous return, causing blood congestion in the spleen, eventually resulting in splenic enlargement and hardening.

Different degrees of splenomegaly may correspond to the following diseases:

• Mild splenomegaly with a soft texture is commonly seen in acute or chronic viral hepatitis, typhoid fever, miliary tuberculosis, acute malaria, infective endocarditis, and sepsis.
• Moderate splenomegaly with a firm texture often occurs in cirrhosis, post-malaria sequelae, chronic lymphocytic leukemia, chronic hemolytic jaundice, lymphoma, and systemic lupus erythematosus.
• Severe splenomegaly with a smooth surface is observed in chronic myeloid leukemia, kala-azar, chronic malaria, and myelofibrosis; an irregular or nodular surface suggests lymphoma or malignant histiocytosis.