Diagnosis
An enlarged spleen is usually detected during a physical exam. Your doctor can often feel it by gently examining your left upper belly. However, in some people — especially those who are slender — a healthy, normal-sized spleen can sometimes be felt during an exam.
Your doctor might order these tests to confirm the diagnosis of an enlarged spleen:
- Blood tests, such as a complete blood count to check the number of red blood cells, white blood cells and platelets in your system and liver function
- Ultrasound or CT scan to help determine the size of your spleen and whether it's crowding other organs
- MRI to trace blood flow through the spleen
Finding the cause
Sometimes more testing is needed to find the cause of an enlarged spleen, including a bone marrow biopsy exam.
A sample of solid bone marrow may be removed in a procedure called a bone marrow biopsy. Or you might have a bone marrow aspiration, which removes the liquid portion of your marrow. Both procedures might be done at the same time.
Liquid and solid bone marrow samples are usually taken from the pelvis. A needle is inserted into the bone through an incision. You'll receive either a general or a local anesthetic before the test to ease discomfort.
A needle biopsy of the spleen is rare because of the risk of bleeding.
Your doctor might recommend surgery to remove your spleen (splenectomy) for diagnostic purposes when there's no identifiable cause for the enlargement. More often, the spleen is removed as treatment. After surgery to remove it, the spleen is examined under a microscope to check for possible lymphoma of the spleen.
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Treatment
Treatment for an enlarged spleen focuses on the what's causing it. For example, if you have a bacterial infection, treatment will include antibiotics.
Watchful waiting
If you have an enlarged spleen but don't have symptoms and the cause can't be found, your doctor might suggest watchful waiting. You see your doctor for reevaluation in 6 to 12 months or sooner if you develop symptoms.
Spleen removal surgery
If an enlarged spleen causes serious complications or the cause can't be identified or treated, surgery to remove your spleen (splenectomy) might be an option. In chronic or critical cases, surgery might offer the best hope for recovery.
Elective spleen removal requires careful consideration. You can live an active life without a spleen, but you're more likely to get serious or even life-threatening infections after spleen removal.
Reducing infection risk after surgery
After spleen removal, certain steps can help reduce your risk of infection, including:
- A series of vaccinations before and after the splenectomy. These include the pneumococcal (Pneumovax 23), meningococcal and haemophilus influenzae type b (Hib) vaccines, which protect against pneumonia, meningitis and infections of the blood, bones and joints. You'll also need the pneumococcal vaccine every five years after surgery.
- Taking penicillin or other antibiotics after your surgery and anytime you or your doctor suspects the possibility of an infection.
- Calling your doctor at the first sign of a fever, which could indicate an infection.
- Avoiding travel to parts of the world where certain diseases, such as malaria, are common.
Lifestyle and home remedies
Avoid contact sports — such as soccer, football and hockey — and limit other activities as recommended to reduce the risk of a ruptured spleen.
It's also important to wear a seat belt. If you're in a car accident, a seat belt can help protect your spleen.
Finally, be sure to keep your vaccinations up to date because your risk of infection is increased. That means at least an annual flu shot, and a tetanus, diphtheria and pertussis booster every 10 years. Ask your doctor if you need other vaccines.
Aug. 25, 2023