Hypersplenism

Hypersplenism is a cytopenia resulting from blood pooling in the spleen and is almost always associated with splenomegaly.

Pathology

Etiology

There is an almost overwhelming list, some more common causes are given below :

• congestive splenomegaly: cirrhosis, Budd-Chiari syndrome, portal vein obstruction
• infections: viral, malaria, tuberculosis
• inflammation: sarcoidosis, SLE
• chronic hemolytic disorders: hemolytic anemia, polycythemia rubra vera
• malignancy:
  • hematological: myeloproliferative disorders, lymphoma, leukemia, Langerhans cell histiocytosis
  • non-hematological: metastases, sarcoma, hemangioma
• storage disorders: Gaucher disease
• other: primary splenic hyperplasia, hyperthyroidism, wandering spleen

Complications

• splenic rupture
• splenic volvulus
• hemorrhagic and infectious complications due to the pancytopenia

Treatment and prognosis

Hypersplenism does not often require treatment because the cytopenia is often not severe enough to cause significant bleeding . Splenectomy or splenic embolization can be considered if warranted.