Enlarged spleen: symptoms, causes and treatment

The NHS says an enlarged spleen does not always cause symptoms. Spleen pain is usually felt as a pain behind your left ribs and it may be tender when you touch the area. This can be a sign of a damaged, ruptured or enlarged spleen. Doctors can often tell if you have an enlarged spleen by feeling your abdomen.

• Feeling full very quickly after eating, because an enlarged spleen can press on the stomach.

• Discomfort or pain behind your left ribs.

• Anaemia and fatigue.

• Frequent infections.

• Easy bleeding or bruising.

The NHS says signs of a ruptured spleen are pain behind your left ribs with tenderness when you touch the area, and dizziness and a rapid heart rate, which can be a sign of low blood pressure caused by blood loss. It says a ruptured spleen is a medical emergency and to go straight to A&E if you think you have ruptured or damaged your spleen.

NHS inform adds that rupture can happen straight away after a blow to the abdomen, a car accident, a sporting accident or a rib fracture, or it may happen weeks after the injury.

See a GP if you have symptoms that could point to an enlarged spleen, such as persistent left-sided discomfort, feeling full after small meals, unexplained tiredness or repeated infections.

The NHS describes the spleen as a fist-sized organ in the upper left side of the abdomen, next to the stomach and behind the left ribs. It is an important part of the immune system, but you can survive without it because the liver can take over many of its functions.

The NHS lists the spleen's main jobs: it fights invading germs in the blood, controls the level of blood cells (white cells, red cells and platelets), and filters the blood, removing old or damaged red blood cells. Patient.info explains that when the spleen is palpable it has usually reached at least twice its normal size.

If the spleen does not work properly, for example when it is enlarged, it may start to remove healthy blood cells. The NHS says this can lead to anaemia, an increased risk of infection and bleeding or bruising.

The NHS says the spleen can become swollen after an infection or injury, and can also become enlarged as a result of a health condition, such as cirrhosis, leukaemia or rheumatoid arthritis. Patient.info, a professional reference written by UK doctors, gives a fuller list, grouped below. It says that in about 5% of cases no cause can be found.

Patient.info says splenomegaly in children is most commonly caused by infection, autoimmune disorders or haemolysis (breakdown of red blood cells). Infections include glandular fever and cytomegalovirus, usually with swollen glands, and autoimmune causes include juvenile idiopathic arthritis. Inherited conditions such as sickle cell anaemia and hereditary spherocytosis, and in some cases cancers such as leukaemia and lymphoma, can also be responsible.

Patient.info adds that splenic sequestration crisis may develop in young children with sickle cell anaemia and is an emergency.

The NHS says doctors can often tell if you have an enlarged spleen by feeling your abdomen, and a blood test, CT scan or MRI scan can confirm the diagnosis. Because the enlargement is a sign of something else, the next step is to find out why.

Patient.info says imaging by MRI or PET scan may be required in some cases, and lists liver, bone marrow and lymph node biopsy among the investigations used to find the cause. It says the doctor should also check for swollen lymph nodes and features of liver disease.

The NHS says the spleen is not usually removed if it is just enlarged. Instead you receive treatment for any underlying condition and your spleen is monitored. You may be prescribed antibiotics if there is an infection, and you need to avoid contact sports for a while.

Patient.info lists blood transfusions where needed and, in some cases, open or laparoscopic splenectomy to control or stage a disease, such as hereditary spherocytosis or Hodgkin lymphoma. The NHS says you may need an operation to remove your spleen (splenectomy) if it is not working properly or it is damaged, diseased or enlarged, and sometimes just part of it can be removed.

The NHS says that if your spleen is removed, other organs such as the liver can take over many of its functions, so you can still cope with most infections, but there is a small risk that a serious infection may develop quickly, for the rest of your life. It recommends being vaccinated against pneumococcal infections (with a booster every 5 years), flu every year, MenACWY and MenB, and taking low-dose antibiotics for at least 2 years and in many cases for life.

The NHS says to see a GP as soon as possible if you get signs of infection such as a high temperature, sore throat, cough, severe headache, a headache with drowsiness or a rash, or abdominal pain. It advises carrying medical ID, being careful about animal and tick bites, and speaking to a GP or pharmacist about antimalarial medicine before travel, because people without a working spleen have an increased risk of a severe form of malaria.

On the NHS, a GP examines you, arranges blood tests and, if needed, an ultrasound or CT scan, then refers you to a specialist depending on the suspected cause, such as a liver or blood specialist.

Some people arrange private blood tests and scans to speed up the first stage. The follow-up tests and treatments are the same, and it is important that your GP receives the results so that vaccination, monitoring and advice on contact sports stay joined up.