When the spleen goes on strike

The spleen is about the size of our fist and is located in the upper left part of our abdomen, just below the lungs. It is important, but not vital for our survival. The most important function of the spleen is to maintain a healthy red blood cell population. It also produces antibodies to fight infection and destroys antibody-coated cells and infecting organisms.

What starts the trouble?

Normally, the spleen’s job is to destroy ageing red cells. But when one suffers from haemolytic anaemia, the spleen malfunctions to destroy more red cells than required. This puts pressure on the spleen and enlarges it. This condition is called splenomegaly, which is often without symptoms. Several other factors can cause the spleen to enlarge. These include: hindrance of blood flow from the spleen [as in liver cirrhosis], increase in white cells [as in lymphoma—cancer of the white cells], and malaria.

How it affects our body

An enlarged spleen:

• causes dragging abdominal pain.
• prevents the stomach from expanding, causing early satiety.
• reduces the number of blood cells in circulation.
• increases the risk of rupture especially in malaria.

What are the treatment options?

Often, a splenic disorder is only a manifestation of a more widespread disorder, usually of the white cells. Treatment of the underlying disease results in relief from symptoms attributable to the spleen. This is particularly true in cases of infections like malaria and kala-azar, and malignancies like leukaemia.

But when the spleen stays diseased, it has to be surgically removed. Other reasons for surgical removal are trauma to the spleen, and enlargement of the spleen leading to the reduction in the number of blood cells [low blood counts cause anaemia and increase the risk of infection and bleeding]. Removing the spleen in the latter case helps normalise the blood count.

How is the surgery performed?

The surgical removal of the spleen is called splenectomy, which may be performed using laparoscopy or by the open technique. Although the laparoscopic splenectomy results in lesser blood loss and has a shorter recovery time, it may not suit all patients. The larger the spleen, less amenable it is to laparoscopic removal.

What happens after splenectomy?

When the spleen is removed, the liver takes over all its functions except one—the immune function. This makes the individual susceptible to infections.

The risk of serious infection is greater in younger children and in patients, who also have other serious diseases like cancer.

Usually, pneumococcus, H. influenzae and meningococcus are the common culprits behind infections. Hence, as a preventive measure against infections, vaccination is given at least two weeks before splenectomy. The vaccine against pneumococcus needs to be repeated every five years.

Patients whose spleen is removed following trauma are vaccinated within 14 days of infection. The patient also needs to be given antibiotics. Penicillin V—an oral penicillin—is used at least for five years in children and two years in adults. Patients allergic to penicillin can be treated with erythromycin.

If your spleen is removed and you are suffering from an infection, it is important to inform the doctor about your splenectomy. This is because the treatment of infections and some other conditions in patients without a spleen is different from that of the others.