For the most part, the spleen is a silent organ. It performs many functions, some of which few understand or recognize until something happens. When the spleen malfunctions and becomes enlarged due to a condition called splenomegaly, an affected person might start to understand how this organ fits into the grand design. Splenomegaly can be a condition on its own or a symptom of something more serious.

The Main Function of the Spleen

The spleen is a multifunctional organ, located in the upper left abdomen, in a region known as the peritoneal cavity. It is the largest organ in the lymphatic system, which helps the body to fight infections. The organ is both a storage facility for white blood cells and platelets and a filter for red blood cells. Its quality control filtration mechanism narrows the passage in a way that allows only healthy red cells to pass through.

The Economy of the Spleen

The spleen is an economical organ when it comes to dealing with waste. Instead of discarding unfit red blood cells, it ensures they are broken down and recycled. Useful parts are saved and returned to the body. For example, iron from damaged red cells goes back to the bone marrow, which uses it to form the protein hemoglobin.

Healthy vs. Enlarged Spleen

A healthy adult spleen weighs between five and six ounces and measures between 4.3 to 4.7 inches. It is undetectable during a routine medical exam. In the case of mild splenomegaly, the spleen is larger than 4.7 inches but smaller than 7.9 inches, and the doctor can feel it. Severe splenomegaly means the spleen is larger than 7.9 inches and is likely a symptom of a more serious disease, requiring additional testing.

Splenomegaly Causes

An enlarged spleen means the body is fighting something — it is just a matter of understanding what it is. The physician will consider the following possibilities when making an initial diagnosis:

• Infections – Is there a bacterial, viral, or fungal infection at work? In some cases, treatment options may be as simple as a prescription.
• Physical Trauma – A sudden blow to the upper abdomen may result in a swollen spleen that needs time to heal.
• Chronic diseases – Anemia and lupus are disorders of the blood and immune system that rely heavily on the spleen.

Symptoms of Enlarged Spleen

People with enlarged spleens may have no symptoms. In such cases, the doctor may take a wait-and-see approach for six to 12 months. However, if an individual begins to bleed more easily than normal, is anemic, or has frequent infections, that is cause for concern. Those with noticeable pain or fullness in the upper left abdomen that gets worse with deeper breathing should seek medical treatment immediately.

Recognizing Splenic Rupture

The most significant risk of an enlarged spleen is a rupture, which can be life-threatening if it causes bleeding in the abdominal cavity. While splenomegaly may not present with symptoms, a splenic rupture is often easier to recognize. Symptoms include persistent pain that travels from the abdomen to the left shoulder, as well as obvious signs of dizziness or confusion, nausea, and vomiting.

Diagnosing Splenomegaly

Apart from a regular exam, doctors can order certain tests to understand the cause of an enlarged spleen. These may include a simple test to count the number of red and white blood cells, a CT scan or ultrasound to check the size of the spleen relative to other organs, to determine whether it is pushing against those organs, and an MRI to examine blood flow and detect any blockages. If the doctor needs more details, she may order a liver function and bone marrow exam to learn more about a patient’s blood cell function.

Who is at Risk?

Certain groups are more likely to develop splenomegaly than others:

• Sickle cell disease is a prevalent condition within the African American/Black community and can cause blood to pool in the spleen.
• Ashkenazi Jews are prone to inherited disorders such as Gaucher’s and Niemann-Pick; an enlarged liver and spleen are symptoms
• Children who have mononucleosis are at risk of developing an enlarged spleen.

When to Consider a Splenectomy

In cases where the cause is unclear or requires a more radical response, splenomegaly patients have two surgical options: partial or complete splenectomy. A partial splenectomy enables the patient to maintain some spleen function and reduces the probability of infection. According to a May 2018 study, humans need as little as 25 to 30 percent of the spleen to maintain a good immune response. However, in the cases of chronic illnesses, a complete splenectomy may be the best option.

Life Without a Spleen

While the spleen is important, it is not vital. Living without a spleen is possible but does carry a set of risks of which individuals should be aware. Because of the organ’s significance to the immune system, people without a spleen are more prone to infections. These people should get vaccines before and after any surgery, and periodic boosters. They are at increased risk of pneumonia, meningitis, and other infections. Additionally, fevers can be more serious and require medical treatment. Finally, travelers with splenomegaly, or those who have had a splenectomy, need to avoid regions where malaria is prevalent because their bodies cannot filter parasite-infected blood properly.