Is your spleen working too hard? (Hypersplenism) Let's learn about it simply!

Do you sometimes feel tired? Or do you have a small wound that won't stop bleeding? Maybe you have blue spots on your body? Sometimes these can be caused by the spleen , a small organ inside our body , being overactive . Today, let's talk about this condition (Hypersplenism), as simply as talking to a friend.

What is this (Hypersplenism)?

Simply put, hypersplenism is when your spleen is working too hard. One of the main functions of the spleen is to remove old, damaged cells from our blood. The spleen works like a garbage collector in our house. But sometimes, when the spleen starts working too hard , it starts removing healthy blood cells faster than it should. That's when our body experiences a shortage of blood cells, or ``Cytopenia''. It's like the good stuff is being removed too quickly.

How does this condition affect your body?

Hypersplenism can cause a decrease in some or all types of blood cells in your body. This can lead to conditions like:

• Anemia : This is a decrease in red blood cells . Red cells are what carry oxygen throughout our bodies. So when they are low, you may feel tired all the time, feel cold, sometimes feel dizzy, and have difficulty breathing . It's like your body is running out of fuel.
• Leukopenia: This is a decrease in white blood cells. White cells are like the 'soldiers' in our body that fight disease. So when white cells are low, the risk of developing diseases increases. Things like fever and colds can happen frequently.
• Thrombocytopenia: This is a decrease in platelets. Platelets help blood clot. They are essential for stopping bleeding, even from a small wound. So when they are low , it can be difficult to stop bleeding, bruises may appear on the body, and the gums may bleed .

This condition (hypersplenism) can be very mild for some people, and it can be quite severe for others. The degree of reduction in blood cells also varies from person to person. Some people may not feel any significant effects and may not need treatment. However, especially if this condition occurs with another serious underlying disease, it can be a significant factor affecting your overall health.

How does hypersplenism occur?

Hypersplenism is often caused by your spleen becoming abnormally large (`(Splenomegaly)`). Think about it, as your spleen gets bigger, the amount of blood it can hold increases. Then, the spleen holds more blood cells at once. As it holds on like this, it also increases the amount of blood it filters out, eventually even starting to remove more healthy cells than it should.

Here are some of the main causes of an enlarged spleen (hypersplenism):

• Liver disease : Conditions that affect your liver, such as chronic hepatitis or cirrhosis, can cause increased pressure in the blood vessels that carry blood through the liver and spleen . This is called portal hypertension. This causes the blood volume in the spleen to increase, causing the spleen to swell, or become enlarged.
• Infections: Some viral infections, such as mononucleosis (also known as kissing disease) and HIV, bacterial infections (such as tuberculosis, endocarditis, an infection of the lining of the heart), and parasitic infections (such as malaria, toxoplasmosis) can put a lot of strain on the spleen's immune system. This causes the spleen to produce more antibodies and immune cells than it needs. This overproduction of cells (hyperplasia) can increase the overall size of the spleen.
• Autoimmune diseases: Long-term inflammatory conditions such as lupus, sarcoidosis, and rheumatoid arthritis can cause the immune system to become overactive, leading to hyperplasia (overproduction of spleen cells). This is when our own immune system attacks our own cells.
• Cancer: In blood-related cancers such as leukemia or myeloproliferative neoplasms (MPNs) and lymphomas, cancer cells enter the spleen and start multiplying there. This also causes the spleen to enlarge.
• Blood disorders: Conditions that cause red blood cells to be destroyed quickly, such as hemolytic anemia (in which red blood cells are destroyed quickly) and neutropenia, put a heavy burden on the spleen, which is responsible for removing them. Just as we get tired when we work too hard.
• Inherited metabolic disorders:Conditions that cause various substances to accumulate in the blood and deposit in organs, such as Niemann-Pick disease, Gaucher disease, and sickle cell disease, can also affect the spleen, causing it to enlarge.

What are the symptoms of (Hypersplenism)?

Sometimes you may have hypersplenism but not have any symptoms. That's the problem with this. However, if symptoms do appear, they can include:

• Symptoms of an enlarged spleen:
• You may feel pain or discomfort in your upper left abdomen . For some, this may just feel like a heaviness.
• Sometimes you can feel the spleen when you touch it with your hand. Normally, we don't feel the spleen like that.
• Because the enlarged spleen presses on the stomach underneath it, you may feel full even after eating a small amount of food . This can also lead to a loss of appetite.
• Symptoms of Anemia: As we have already discussed, red blood cells are what carry oxygen to the tissues of our body. So when there are not enough of them, the tissues become deprived of oxygen. As a result:
• You may feel dizzy, weak, and fatigued (feeling tired even after doing a little work).
• You may just feel cold and have frequent headaches .
• Your skin may look pale . Others may look at your face and ask, "Why are you pale?"

If you have one or more of these symptoms, it is very important to see a doctor for advice.

How do you know if you have hypersplenism?

A doctor will first check to see if your spleen is enlarged (`(Splenomegaly)`) and will also measure the number of cells in your blood.

• Sometimes, your doctor may feel your enlarged spleen during a physical exam . The doctor will feel the left side of your abdomen.
• An ultrasound can be done to confirm this. This can accurately measure the size of the spleen.
• A complete blood count (CBC) test can tell exactly which types of cells (red cells, white cells, platelets) are low in your blood and how low they are. This is the most important test.

How is Hypersplenism treated?

Hypersplenism is often a side effect and a sign of another, more serious underlying condition. So, if you have not yet been diagnosed with the underlying condition or have not started treatment for it, your doctor will focus on that first. Your doctor will also need to do more tests to find the exact cause. When the underlying cause is treated, the spleen's function will often return to normal.

Treatment for hypersplenism depends on its severity. It may include:

• Blood transfusion: Your low blood cell count is restored with donated blood. This can be done by giving red cells if your red blood cells are low, or platelets if your platelets are low.
• Low-dose radiation therapy or radiofrequency ablation: Both of these methods are used by doctors to target and destroy tissue in the body, such as cancerous tumors. These methods can be used to treat hypersplenism and shrink your enlarged spleen back to its normal size. Your doctor may recommend this if your hypersplenism is severe and the underlying condition cannot be treated to shrink the spleen.
• Splenectomy: In some severe cases, if other treatments have not worked, your doctor may suggest removing part or all of your spleen. You can live without a spleen, but it weakens your immune system. Given your underlying medical condition, this may do more harm than good. Therefore, splenectomy is usually done as a last resort. If you have this surgery, your doctor may recommend that you get some special vaccines to protect you from common infections. In some cases, you may also be prescribed prophylactic antibiotics to take daily after your spleen is removed.

What can I expect with this situation?

Hypersplenism is a treatable condition. However, your prognosis depends on the underlying condition you have. Some conditions are temporary (e.g., some infections), some are chronic (e.g., cirrhosis, some autoimmune diseases), and some are progressive (e.g., some cancers). If hypersplenism causes low blood cell counts (e.g., cytopenia), a blood transfusion can help restore your blood cell count. The most important thing is to work closely with your doctor and follow your treatment plan carefully.

What is the difference between (Hypersplenism) and (Splenomegaly)?

There can be a little confusion when talking about these two, so let's clarify that as well.

• Splenomegaly means your spleen is abnormally large .
• Hypersplenism is when the enlarged spleen becomes overactive and removes too many blood cells.

Simply put, Hypersplenism is a side effect of Splenomegaly. Various things can cause the spleen to become enlarged and overactive. However,Hypersplenism doesn't always occur because the spleen is enlarged. That is, not every spleen that is overactive is enlarged, but not every enlarged spleen is overactive. Get it? It's like not everyone who has a big car drives fast, but someone who drives fast is usually more likely to choose a bigger, more powerful vehicle.

Hypersplenism is basically a symptom of another medical condition. There may be a disease in your spleen itself, or it may start somewhere else in your body. Because your spleen is involved in storing and filtering blood, diseases that affect it can often be related to your blood or blood vessels.

Treating hypersplenism usually involves treating the underlying condition. In most cases, the spleen itself can be restored to normal function. However, if your condition persists, you may need blood transfusions to restore your blood cell count, or your doctor may decide to treat your spleen directly.

So, what are the things we need to remember from all of this? (Take-Home Message)

Okay, we've talked a lot about hypersplenism. Here are a few simple things to keep in mind:

• Hypersplenism is when your spleen overworks and removes more blood cells (red cells, white cells, platelets) than necessary.
• The main cause of this is an enlarged spleen (`(Splenomegaly)`) . An enlarged spleen can be caused by various underlying diseases such as liver disease, infection, and cancer.
• If you experience symptoms such as frequent fatigue, getting sick easily, bleeding that takes a long time to stop even from a small wound, pain in the upper left part of your stomach, and feeling full even after eating a small amount of food, it is important to seek medical advice.
• Hypersplenism is treated by treating the underlying condition. Sometimes, blood cell transfusions, treatments to reduce the size of the spleen, or, as a last resort, removal of the spleen may be necessary.
• This is a treatable condition. So it's important not to panic and follow your doctor's instructions carefully.

Remember, if you have these symptoms, it's best to talk to a doctor without being afraid. They can then run the necessary tests, find out exactly what's wrong, and provide the necessary treatment. The sooner you are diagnosed, the easier the treatment will be and the better the outcome.