Hypersplenism: Causes, Symptoms, Treatment and Cost

Hypersplenism is a disorder that causes the spleen to expand and become hyperactive. As a result, it filters out an excessive number of red and white blood cells, as well as platelets, from the bloodstream. As a result, people with hypersplenism may experience anaemia, thrombocytopenia (a low platelet count), and leukopenia (a low white blood cell count).

• Primary Hypersplenism: It is a condition in which the spleen enlarges and increases its activity, so it removes abnormally large quantities of red and white blood cells from the circulation. It is often brought on by liver cirrhosis.
• Secondary Hypersplenism: It is a condition in which the spleen enlarges due to an underlying disorder, such as an autoimmune disorder or a chronic inflammatory disorder. This type of hypersplenism can also be caused by certain types of infections, such as malaria or bacterial infections.
• Congenital Hypersplenism: It is a rare inherited disorder in which the spleen enlarges and increases its activity at birth due to abnormal development of certain organs or tissues in the body.

Primary causes:

• Autoimmune disorders such as lupus, rheumatoid arthritis, and other inflammatory diseases can lead to hypersplenism.
• It may sometimes be brought on by an infection or a congenital abnormality.
• Furthermore, cancers such as lymphoma and leukaemia may cause this condition.

Secondary causes:

• Liver diseases like cirrhosis, portal hypertension, and Budd-Chiari syndrome can lead to hypersplenism.
• The spleen may enlarge and become hyperactive due to blood illnesses such as sickle cell anaemia and thalassemia.
• Splenic vein thrombosis is another potential cause of hypersplenism.

• The most noticeable sign of hypersplenism is spleen enlargement. This manifests as a solid mass in the upper left abdominal region.
• Symptoms associated with hypersplenism include anaemia, fatigue, fever, weight loss and jaundice.
• Other common symptoms include easy bruising or bleeding, increased susceptibility to infections and pain in the left upper quadrant of the abdomen.
• Hypersplenism can also cause abnormalities in other organs such as the liver, which may lead to liver dysfunction and abnormal liver enzyme levels.
• Hypersplenism can cause splenic sequestration which is where red blood cells are trapped in the spleen and are not released into circulation resulting in severe anaemia.

• Avoiding infection: The most important way to reduce the risk of hypersplenism is to avoid infections, especially those caused by viruses or bacteria. This may be accomplished by measures such as routine hand washing and avoiding contact with sick people.
• Vaccinations: Vaccines can help prevent some infections that can lead to hypersplenism, such as hepatitis B and pneumococcal pneumonia. It is important to make sure that you and your family are up-to-date with vaccines recommended for your age group.
• Regular medical checkups: People at risk of developing hypersplenism should have regular physical checkups to assess the size of their spleen and the presence of any abnormal cells in the blood.
• Eating a healthy diet: Eating well will help keep your immune system strong, which in turn can lower your chances of having hypersplenism.
• Avoiding alcohol: Excessive alcohol consumption can weaken the immune system and increase the risk of infection, which could trigger an episode of hypersplenism or make it worse if it already exists.

• Complete Blood Count (CBC): A complete blood count (CBC) is a blood test that counts the amount of red blood cells, white blood cells, and platelets in a blood sample. It may also measure other components, such as haemoglobin and hematocrit levels, which can help diagnose anaemia or other conditions.
• Blood Smear: A blood smear is a lab test that uses a small sample of your blood to examine the shape and size of your red and white blood cells. It can help diagnose conditions such as anaemia, infection, or other disorders in which the number or shape of your blood cells are abnormal.
• Liver Function Tests: Liver function tests are used to evaluate the health of your liver and determine if there is damage due to diseases like hepatitis or cirrhosis. These tests measure levels of certain enzymes and proteins in your blood that can be indicative of liver damage or dysfunction.
• Splenomegaly Imaging: Imaging tests such as X-rays, CT scans, MRI scans, or ultrasound may be used to assess the size of your spleen. An enlarged spleen (splenomegaly) is often associated with hypersplenism and can help make a diagnosis.
• Bone Marrow Biopsy: A bone marrow biopsy is a procedure in which a small sample of bone marrow is removed with a needle for laboratory analysis. It can be used to check for abnormalities in the production of blood cells, including hypersplenism, and to diagnose certain types of cancers or infections such as leukaemia or HIV/AIDS.

• Anaemia: Hypersplenism can cause a decrease in red blood cells, leading to anaemia. This may result in a variety of unpleasant signs and symptoms, including tiredness, headaches, weakness, dizziness, pale skin, and difficulty breathing.
• Thrombocytopenia: Platelets are crucial for clotting blood, and hypersplenism may cause platelet levels to drop. This can result in excessive bleeding or bruising and an increased risk of infection.
• Splenic Infarction: In some cases, a splenic infarction (blockage of blood supply) may occur due to hypersplenism. Fever and upper left abdominal pain may result from this.
• Portal Hypertension: Hypersplenism can also cause portal hypertension, where there is an increase in the pressure within the portal vein that carries blood from the intestines to the liver. This can lead to further complications such as ascites (fluid build-up in the abdomen), variceal bleeding (bleeding from enlarged veins), and hepatic encephalopathy (damage to the brain due to liver dysfunction).

• Amalaki (Emblica officinalis): Amalaki is an Ayurvedic herb that helps to reduce hypersplenism. Moreover, it aids in boosting the immune system and lowering bodily inflammation.
• Ashwagandha (Withania somnifera): This Ayurvedic herb has anti-inflammatory and immunomodulatory properties that can help reduce inflammation and boost immunity. It can also help protect the liver, spleen, and other organs from damage caused by hypersplenism.
• Bhringaraj (Eclipta alba): Bhringaraj is an Ayurvedic herb that helps to reduce inflammation and improve digestion, which can help reduce some of the symptoms of hypersplenism.
• Turmeric (Curcuma longa): Strong anti-inflammatory qualities of turmeric may be helpful for patients with hypersplenism and may help decrease inflammation in the body.
• Ginger (Zingiber officinale): Ginger is a powerful anti-inflammatory herb that helps to reduce inflammation in the body and may be beneficial for those with hypersplenism.

• Foods that are low in saturated fat, such as lean meats, fish, vegetables, and fruits, should be included in the diet.
• Foods rich in vitamin B12, such as eggs, meat, poultry and dairy products should be consumed regularly to prevent anaemia.
• Iron-rich foods like red meat, legumes and dark leafy greens can also help boost iron levels in the body.
• Yogurt and other probiotic foods may assist with maintaining appropriate levels of helpful bacteria in the stomach and alleviate the inflammation caused by hypersplenism.
• Drinking plenty of fluids throughout the day is essential for maintaining adequate hydration levels and preventing dehydration-related complications associated with hypersplenism.

• Alcoholic beverages: Alcohol can worsen the symptoms of hypersplenism, as it can cause further damage to the spleen.
• Fatty foods: Fatty and greasy foods can put extra strain on the liver and spleen, which can cause them to become enlarged.
• Raw or undercooked food: Raw or undercooked food has a high risk of containing harmful bacteria and viruses, which can worsen symptoms of hypersplenism.
• High-fibre foods: High-fibre foods such as bran, nuts, and legumes can be difficult for people with hypersplenism to digest and may cause abdominal discomfort or a feeling of fullness.
• Dairy products: Dairy products such as milk, cheese, and yoghurt are difficult for people with hypersplenism to digest and may cause abdominal discomfort or a feeling of fullness.

• Splenectomy: This is a surgical procedure to remove the spleen, which is the organ that is overactive in hypersplenism. Removal of the spleen can reduce the symptoms and help improve overall health.
• Splenic Embolization: This procedure involves blocking off the blood vessels that supply blood to the spleen, thus reducing its size and activity. The advantage of this procedure is that it does not require surgery, but can be done through a minimally invasive catheter-based procedure.
• Endovascular Embolization: This is a more advanced technique than splenic embolization, and involves inserting small coils or particles into the splenic artery to block off its blood supply. This can also be done via a minimally invasive approach, with much less risk than open surgery.
• Splenopexy: This procedure involves surgically moving or reattaching the spleen to another location in the abdomen so as to reduce its activity and size without completely removing it from the body.

• To diagnose and treat hypersplenism, one should consult a haematologist or an internist.
• A haematologist is a doctor who specialises in diagnosing and treating blood-related ailments, such as anaemia, bleeding disorders, and immune system abnormalities.
• An internist is a general practitioner who diagnoses and treats common medical diseases and provides preventive care for adults.
• Both haematologists and internists can diagnose hypersplenism and suggest treatments to help manage it, such as medications or surgery if necessary.

• Antibiotics: These are used to treat bacterial infections, such as pneumonia, that can cause hypersplenism. Examples include ciprofloxacin, amoxicillin, and metronidazole.
• Anti-inflammatory medications: These are used to reduce inflammation in the spleen and other organs affected by hypersplenism. Examples include ibuprofen, corticosteroids, and sulfasalazine.
• Immunosuppressants: These drugs reduce the body's immune response and help to prevent overproduction of white blood cells that can contribute to hypersplenism. Examples include azathioprine and cyclosporine A.
• Blood thinners: These drugs help prevent clots in the spleen and other organs affected by hypersplenism. Examples include heparin and warfarin.
• Iron supplements: These are used to replace iron lost as a result of frequent red blood cell destruction associated with hypersplenism. Examples include ferrous sulphate and iron gluconate.

The time needed to heal might range from a few weeks to many months.

In some cases, recovery may take longer depending on how severe the underlying cause is and how well the patient responds to treatment.

Treatment's effects won't last forever, unfortunately.

The treatment is designed to provide relief from symptoms and to reduce the severity of the condition, but it is not a cure, and further treatments may be required depending on the individual's condition.

• Monitor red blood cell and platelet counts regularly, as well as liver function tests and other blood tests, to detect any recurrence of the condition.
• Avoid contact sports and strenuous activities that could lead to trauma or injury, which can cause excessive bleeding due to low platelet counts.
• Avoid engaging in activities that might lead to infection, such as swimming in a contaminated lake or river.
• Take vitamin B12 supplements if indicated by your doctor to prevent anaemia caused by lack of B12 absorption in the spleen.
• Consult your doctor before taking any herbal supplements or over-the-counter medications, as some may interact with other medications you are taking for hypersplenism or its symptoms.

Generally, the treatments range from medical management to surgical procedures such as splenectomy.

The cost could range from approximately Rs. 10,000 to Rs. 2,00,000 depending on the type of the treatment and the seriousness of the ailment. For example, if a patient requires a splenectomy, it could cost up to Rs. 1 lakh or more depending on the hospital and other factors such as doctor fees and medicines.

• Bleeding: Hypersplenism treatment may cause bleeding due to the destruction of platelets and other clotting factors in the spleen.
• Infections: Hypersplenism treatment may reduce the ability of the body to fight off infections, as it can reduce white blood cells and platelets in the bloodstream.
• Anaemia: Hypersplenism treatments may cause anaemia, which is a decrease in red blood cells due to destruction of red blood cells by the spleen.This may result in fatigue, shortness of breath, and pale skin.
• Fatigue: Treatments for hypersplenism can cause fatigue due to the destruction of red blood cells by the spleen, leading to anaemia and lack of oxygen delivery throughout the body.
• Pain: Some treatments for hypersplenism can cause pain or discomfort due to removal or destruction of part or all of the spleen tissue.

If you are experiencing issues related to Hypersplenism, you should visit a doctor, as they might cause 'anaemia, thrombopenia, splenic infarction, etc.' for which the treatment period can vary from a few months to several years, depending on the severity of the problem.