Intro
The spleen is a spongy, soft organ about as big as a person’s fist, is located in the upper left part of the abdomen, just under the rib cage. The splenic artery brings blood to the spleen from the heart.
Blood leaves the spleen through the splenic vein, which drains into a larger vein (the portal vein) that carries the blood to the liver. The spleen has a covering of fibrous tissue (the splenic capsule) that supports its blood vessels and lymphatic vessels.
The spleen is made up of two basic types of tissue, each with different functions:
- White pulp
- Red pulp
*The white pulp is part of the infection-fighting system (immune system). It produces white blood cells called lymphocytes, which in turn produce antibodies (specialized proteins that protect against invasion by foreign substances).
*The red pulp filters the blood, removing unwanted material. The red pulp contains other white blood cells called phagocytes that ingest microorganisms, such as bacteria, fungi, and viruses. It also monitors red blood cells, destroying those that are abnormal or too old or damaged to function properly.
In addition, the red pulp serves as a reservoir for different elements of the blood, especially white blood cells and platelets (cell-like particles involved in clotting). However, releasing these elements is a minor function of the red pulp.
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- Intro
- Viewing the Spleen
- On this page
- Where to get help
- Spleen structure
- Disorders of the spleen
- Diagnosis of spleen disorders
- Treatment for spleen disorders
- Recovery after splenectomy
- Spleen problems and spleen removal
- An enlarged spleen
- Surgery to remove the spleen
- Open surgery
- Living without a spleen
- Vaccinations
- Signs of infection include
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Viewing the Spleen
- Asplenia
- People can live without a spleen (a condition called asplenia).
- Asplenia is loss of splenic function due to
- Absence of the spleen at birth
- A disease that affects the function of the spleen (functional asplenia)
- Surgical removal of the spleen (splenectomy)
- Absence of the spleen at birth is a rare disorder.
- Infants with this disorder often also have a heart defect.
People with functional asplenia have a spleen that does not function properly. Functional asplenia can be due to a variety of diseases.
Common causes include sickle cell disease, celiac disease, and alcoholic liver disease.
Functional asplenia can also occur after injury to the arteries or veins of the spleen.
Splenectomy is surgical removal of the spleen. It can be done in otherwise healthy people who require splenectomy after a spleen injury (such as after a motor vehicle accident) or in people with diseases that cause the spleen to enlarge and therefore require splenectomy.
When the spleen is removed or does not function, the body loses some of its ability to produce protective antibodies and to remove unwanted microorganisms from the blood.
As a result, the body’s ability to fight infections is impaired.
However, other organs (primarily the liver) compensate for the loss by increasing their infection-fighting ability and by monitoring for and removing red blood cells that are abnormal, too old, or damaged.
People who do not have a spleen are at particularly high risk of infections because of the spleen’s role in fighting certain kinds of bacteria, such as Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae.
Major functions of the spleen include removing abnormal blood cells and making components of the immune system.
Since the spleen is involved in so many bodily functions, it is vulnerable to a range of disorders. Disorders of the spleen include Splenomegaly, Hypersplenism and Splenic rupture.
On this page
- Spleen structure
- Disorders of the spleen
- Diagnosis of spleen disorders
- Treatment for spleen disorders
- Recovery after splenectomy
- Immunizations and splenectomy
Where to get help
The spleen is located on the left side of the abdomen and weighs around 200 g in the average healthy adult. The spleen can be considered as two organs in one. It filters the blood and removes abnormal cells (such as old and defective red blood cells), and it makes disease-fighting components of the immune system (including antibodies and lymphocytes).
Since the spleen is involved in so many bodily functions, it is vulnerable to a wide range of disorders. However, the human body adapts well to life without this organ, so surgically removing a diseased or damaged spleen is possible without causing any serious harm to the person.
Spleen structure
The body of the spleen appears red and pulpy, surrounded by a tough capsule. The red pulp consists of blood vessels (splenic sinusoids) interwoven with connective tissue (splenic cords). The red pulp filters the blood and removes old and defective blood cells. The white pulp is inside the red pulp, and consists of little lumps of lymphoid tissue.
Antibodies are made inside the white pulp. Similarly to other organs of the lymphatic system, particular immune cells (B lymphocytes and T lymphocytes) and blood cells are either made or matured inside the spleen. Blood enters the spleen via the splenic artery, which subdivides into many tiny branches. Each branch is encased in a clump of lymphocytes, which means every drop of blood is filtered for foreign particles as it enters the spleen.
Disorders of the spleen
Some of the disorders that can affect the spleen include:
- splenomegaly
- hypersplenism
- splenic rupture.
Splenomegaly
A variety of disorders can cause the spleen to enlarge, sometimes to 2kg or more. Any conditions that cause a rapid breakdown of blood cells, such as Haemolytic Anaemias, can place great strain on the spleen and make it enlarge. Other causes of splenomegaly include infections (such as glandular fever), liver disease and some cancers (such as Hodgkin’s disease, leukaemia and lymphoma).
Hypersplenism
The two characteristic features of hypersplenism are splenomegaly and a deficiency of one or more blood components. It seems that an enlarged spleen is sometimes overactive and will destroy more blood cells than necessary.
Symptoms depend on which blood component is lacking. For example, if red blood cells are deficient, anaemia will be the result (with symptoms including fatigue and pallor). Most cases of hypersplenism are caused by disorders somewhere else in the body, such as cirrhosis of the liver.
Splenic rupture
Certain disorders, including glandular fever, can occasionally make the enlarged spleen delicate enough to spontaneously rupture. A sudden blow to the abdomen can split the outer capsule of the spleen and cause bleeding into the abdominal cavity. There are various degrees of splenic rupture. When bleeding is life threatening, surgery to remove the spleen (splenectomy) is needed.
Diagnosis of spleen disorders
Depending on the condition under investigation, disorders of the spleen can be diagnosed using a number of tests, including:
- physical examination
- blood tests
- ultrasound
- computed tomography (CT) scan
- bone marrow biopsy
- other tests to check for underlying disorders.
Treatment for spleen disorders
Treatment depends on the disorder and its specific cause. For example, if the splenomegaly is caused by particular cancers (including Hodgkin’s disease, leukaemia or lymphoma), then treatment will focus on eliminating or controlling the primary disease.
Hypersplenism, triggered by cirrhosis of the liver, can be treated with abstinence from alcohol and special dietary modifications. A severely ruptured spleen is usually surgically removed.
Recovery after splenectomy
The surgical removal of the spleen is called a splenectomy. The body can cope without the spleen, although the person might be more susceptible to infections after the operation. Their blood may also contain odd-shaped red blood cells. In some cases, it is possible to remove only the diseased or damaged parts of the spleen. This allows the remaining healthy portions to keep functioning as normal.
Immunizations and splenectomy
People who have had their spleen removed or have a spleen disorder are at increased risk of infection, most commonly pneumococcal infection .Some vaccines are recommended especially for these people and they should be discussed with the doctor.
They are:
- pneumococcal vaccine
- meningococcal vaccines
Haemophilus influenzae type b vaccine (recommended in an adult who has close contact with children less than 5 years of age)
Spleen problems and spleen removal
Some people are born without a spleen or need to have it removed because of illness or injury.
The spleen is a fist-sized organ in the upper left side of your abdomen, next to your stomach and behind your left ribs.
It's an important part of your immune system, but you can survive without it. This is because the liver can take over many of the spleen's functions.
What does the spleen do?
- The spleen has some important functions:
- it fights invading germs in the blood (the spleen contains infection-fighting white blood cells)
- it controls the level of blood cells (white blood cells, red blood cells and platelets)
- it filters the blood and removes any old or damaged red blood cells
- Spleen problems
- The spleen is not working properly
- If the spleen does not work properly, it may start to remove healthy blood cells.
This can lead to:
- anaemia, from a reduced number of red blood cells
- an increased risk of infection, from a reduced number of white blood cells
- bleeding or bruising, caused by a reduced number of platelets
- A painful spleen
- Spleen pain is usually felt as a pain behind your left ribs. It may be tender when you touch the area.
- This can be a sign of a damaged, ruptured or enlarged spleen.
- A damaged or ruptured spleen
- The spleen can become damaged or may burst (rupture) after an injury, such as a blow to the abdomen, a car accident, a sporting accident or broken ribs.
- Rupture can happen straight away or it may happen weeks after the injury.
Signs of a ruptured spleen are:
- pain behind your left ribs and tenderness when you touch this area
- dizziness and a rapid heart rate (a sign of low blood pressure caused by blood loss)
- Sometimes if you lie down and raise your legs, you can feel the pain at the tip of your left shoulder.
- A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding.
An enlarged spleen
The spleen can become swollen after an infection or injury. It can also become enlarged as a result of a health condition, such as cirrhosis, leukaemia or rheumatoid arthritis.
An enlarged spleen does not always cause symptoms.
Otherwise, look out for:
- feeling full very quickly after eating (an enlarged spleen can press on the stomach)
- feeling discomfort or pain behind your left ribs
- anaemia and fatigue
- frequent infections
- easy bleeding
Doctors can often tell if you have an enlarged spleen by feeling your abdomen. A blood test, CT scan or MRI scan can confirm the diagnosis.
The spleen is not usually removed if it's just enlarged. Instead, you'll receive treatment for any underlying condition and your spleen will be monitored. You may be prescribed antibiotics if there's an infection.
You'll need to avoid contact sports for a while, as you'll be at greater risk of rupturing the spleen while it's enlarged.
Surgery is only necessary if the enlarged spleen is causing serious complications or the cause cannot be found.
Surgery to remove the spleen
You may need an operation to remove your spleen, known as a splenectomy, if it's not working properly or it's damaged, diseased or enlarged.
Sometimes just part of your spleen can be removed, which is called a partial splenectomy.
If there's time, you'll be advised to have certain vaccinations before the operation. This is because spleen removal weakens your immune system and can make you more likely to get an infection.
Laparoscopy
Most operations to remove spleens are carried out using keyhole surgery (laparoscopy).
Keyhole spleen removal allows a surgeon to get inside your tummy (abdomen) to your spleen without having to make large cuts.
This means you'll have less scarring and may recover from the operation more quickly. But you'll still need a general anaesthetic.
The procedure involves:
- making several small cuts in your tummy
- guiding a laparoscope into your body through one of the cuts so doctors can see what they're doing
- passing thin instruments into your tummy through the other cuts to remove your spleen (gas will be pumped into your tummy to make this easier)
- The cuts are then stitched up or sometimes glued together.
- You may be able to go home the same day, or you may need to stay in hospital overnight.
- If you go home the same day, someone will need to stay with you for the first 24 hours.
Open surgery
Open surgery is where one large cut is made.
It may be needed if your spleen is too large or too damaged to be removed using keyhole surgery. Often, in emergencies, this is the preferred method.
You'll need a general anaesthetic and may need to stay in hospital for a few days to recover.
- Recovering from spleen surgery
It's normal to feel sore and be bruised after a splenectomy, but you'll be given pain relief.
You should be able to eat and drink as normal soon after the operation.
Like any operation, spleen removal carries a small risk of complications, including bleeding and infection.
Your doctor will talk through these risks with you.
You should be given breathing and leg exercises to do at home to reduce your risk of getting a blood clot or a chest infection.
Another risk is the surgical wound becoming infected.
If you spot any signs of infection, contact your GP or hospital immediately, as you may need antibiotics.
Recovery usually takes a few weeks. Your doctor or nurse will advise when you can go back to your usual activities, such as driving.
Living without a spleen
If your spleen needs to be removed, other organs, such as the liver, can take over many of the spleen's functions.
This means you'll still be able to cope with most infections.
But there's a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.
Young children have a higher risk of serious infection than adults, but the risk is still small.
The risk is also increased if you have a health condition like sickle cell anaemia or coeliac disease, or a health condition that affects your immune system, like HIV.
This risk can be minimised by following simple precautions to prevent infection.
Vaccinations
Check with your GP surgery that you have had all your routine NHS vaccinations.
You should also be vaccinated against:
- Pneumococcal infections, such as Pneumonia, with a booster every 5 years
- Flu (get the flu vaccine every year)
- MenACWY
- MenB
- Antibiotics
- It's recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections.
- Antibiotics are particularly important:
- For children under the age of 16
- For the first 2 years after your spleen is removed
- If your immune system does not work properly
- Be alert for signs of infection
- See a GP as soon as possible if you get signs of an infection.
Signs of infection include:
- a high temperature
- a sore throat
- a cough
- a severe headache
- a headache with drowsiness or a rash
- abdominal pain
- redness and swelling around the surgical wound
- Your GP can prescribe a course of antibiotics for you to use if you get an infection.
- If your infection becomes serious, you may be admitted to hospital.
- Beware of animal and tick bites
- Bites from animals and small blood-sucking parasites called ticks can cause infections.
- If you get bitten by an animal, particularly a dog, start your course of antibiotics if you have them with you, and seek medical advice urgently