Splenomegaly – StatPearls – NCBI Bookshelf

Continuing Education Activity

Splenomegaly is defined as enlargement of the spleen measured by size or weight. The spleen plays a significant role in hematopoiesis and immunosurveillance. The major functions of the spleen include clearance of abnormal erythrocytes, removal of microorganisms and antigens as well as the synthesis of immunoglobulin G (IgG). The spleen also synthesizes the immune system peptides properdin and tuftsin. Approximately one-third of circulating platelets are stored in the spleen. The normal weight of the adult spleen is 70 g to 200 g, spleen weight of 400 g to 500 g indicates splenomegaly spleen weight greater than 1000 g is definitive of massive splenomegaly. This activity reviews the causes, evaluation, and management of splenomegaly and highlights the role of the interprofessional team in managing patients with this condition.

Objectives:

• Identify the etiology of splenomegaly.

• Describe the typical history and physical exam findings in a patient with splenomegaly.

• Outline the treatment and management options for splenomegaly.

• Review interprofessional team strategies for improving care coordination and communication to advance splenomegaly improve outcomes.

Access free multiple choice questions on this topic.

Introduction

Splenomegaly is defined as enlargement of the spleen measured by weight or size. The spleen plays a significant role in hematopoiesis and immunosurveillance. The major functions of the spleen include clearance of senescent and abnormal erythrocytes and their remnants, opsonized platelets and white blood cells and removal of microorganisms and antigens. The spleen also serves as a secondary lymphoid organ and is the site for maturation and storage of T and B lymphocytes, playing an important role in the synthesis of immunoglobulin G (IgG) by mature B-lymphocytes upon interaction with the T-lymphocytes.   The spleen also synthesizes the immune system peptides properdin and tuftsin. Approximately one-third of circulating platelets are stored in the spleen. The normal position of the spleen is within the peritoneal cavity in the left upper quadrant adjacent to ribs 9 through 12. The normal-sized spleen abuts the stomach, colon, and left kidney.

The size and weight of spleen may vary and correlates with weight, height, and sex of an individual, with larger spleen size seen in men compared to women, and in heavier or taller individuals. A normally sized spleen measures up to 12 cm in craniocaudal length.  A length of 12 cm to 20 cm indicates splenomegaly, and a length greater than 20 cm is definitive of massive splenomegaly. The normal weight of the adult spleen is 70 g to 200 g; a spleen weight of 400 g to 500 g indicates splenomegaly and spleen weight greater than 1000 g is definitive of massive splenomegaly. The normal-sized spleen is usually not palpable in adults. However, it may be palpable due to variations in body habitus and chest wall anatomy. Splenomegaly may be diagnosed clinically or radiographically using ultrasound, CT imaging, or MRI.  Splenomegaly may be a transient condition due to acute illness or may be due to serious underlying acute or chronic pathology.[1][2][3]

Etiology

There are several potential causes of splenomegaly. 

1. Liver disease (cirrhosis, hepatitis): Parenchymal liver disease causes increased vascular pressure leading to an increase in spleen size.

2. Hematologic malignancies (lymphomas, leukemias, myeloproliferative disorders): Neoplastic cells cause infiltration of the spleen leading to splenomegaly.

3. Venous thrombosis (portal or hepatic vein thrombosis): This leads to an increase in vascular pressure leading to splenomegaly.

4. Splenic congestion (venous thrombosis, portal hypertension, congestive heart failure).

5. Cytopenias (Immune thrombocytopenic purpura, autoimmune hemolytic anemia, immune-mediated neutropenia, Felty syndrome): Immune-mediated destruction of red blood cells, white blood cells or platelets lead to functional splenomegaly.

6. Splenic sequestration (pediatric sickle cell disease, hemolytic anemias, thalassemias).

7. Acute or chronic infection (bacterial endocarditis, infectious mononucleosis, HIV, malaria, tuberculosis, histiocytosis, abscess).

8. Connective tissue diseases (systemic lupus erythematosus, rheumatoid arthritis, Adult-onset Still’s disease, and some familial autoinflammatory syndromes).[4][5]

9. Infiltrative disorders (sarcoidosis, amyloidosis, glycogen storage diseases).

10. Splenic sequestration (pediatric sickle cell, hemolytic anemias, thalassemias).

11. Focal lesions (hemangiomas, abscess, cysts, metastasis).

The mechanism underlying splenic enlargement varies based on the etiology. In the case of acute infectious illness, the spleen performs increased work in clearing antigens and producing antibodies and increases the number of reticuloendothelial cells contained within the spleen. These increased immune functions may result in splenic hyperplasia. In the case of liver disease and congestion, underlying illness causes increased venous pressure causing congestive splenomegaly. Extramedullary hematopoiesis exhibited in myeloproliferative disorders can lead to splenic enlargement (infiltrative splenomegaly).[6][7]

Splenic sequestration crisis (SSC) is a life-threatening illness common in pediatric patients with homozygous sickle cell disease and beta-thalassemia. Up to 30% of these children may develop SSC with a mortality rate of up to 15%. This crisis occurs when splenic vaso-occlusion causes a large percentage of total blood volume to become trapped within the spleen. Clinical signs include a severe, rapid drop in hemoglobin leading to hypovolemic shock and death. Pediatric patients with sickle cell disease and beta-thalassemia experience multiple splenic infarcts, resulting in splenic fibrosis and scarring. Over time, this leads to a small, auto infarcted spleen typically by the time patients reach adulthood. Splenic sequestration crisis can only occur in functioning spleens which may be why this crisis is rarely seen in adults. However, late adolescent or adult patients in this group who maintain splenic function may also develop the splenic sequestration crisis.

Epidemiology

Splenomegaly is a rare condition, with an estimated prevalence of approximately 2% of the total United States population. In adults, there has been no reported predominance in prevalence based on ethnicity, gender, or age. In Asia and Africa, tropical splenomegaly is very common. In older people, the capsule of the spleen is thin, thus the risk of rupture is higher.

Pathophysiology

Splenomegaly can be classified based on its pathophysiologic mechanism: 

• Congestive, by pooled blood (e.g., portal hypertension)

• Infiltrative, by invasion by cells foreign to the splenic environment (e.g., metastases, myeloid neoplasms, lipid storage diseases)

• Immune, by an increase in immunologic activity and subsequent hyperplasia (e.g., endocarditis, sarcoidosis, rheumatoid arthritis)

• Neoplastic, when resident immune cells originate a neoplasm (e. g., lymphoma).

History and Physical

The most common physical symptom associated with splenomegaly is vague abdominal discomfort. Patients may complain of pain in the left upper abdomen or referred pain in the left shoulder. Abdominal bloating, distended abdomen, anorexia, and/or early satiety may also occur. More commonly, patients will present with symptoms due to the underlying illness causing splenomegaly. Constitutional symptoms such as weakness, weight loss, and night sweats suggest malignant illness. Patients with splenomegaly due to acute infection may present with fever, rigors, generalized malaise, or focal infectious symptoms. Patients with underlying liver disease may present with symptoms related to cirrhosis or hepatitis. Symptoms of anemia (lightheadedness, dyspnea, or exertion), easy bruising, bleeding, or petechiae may indicate splenomegaly due to the underlying hemolytic process.

Physical examination of the spleen is performed with the patient in supine and right lateral decubitus position with neck, hips, and knees flexed. This positioning relaxes abdominal wall musculature and rotates the spleen more anteriorly. Light fingertip pressure is applied below the left costal margin during deep inspiration. The examiner may feel the rounded edge of the spleen pass underneath the fingertips at maximum inspiration. The exam is abnormal if the spleen is palpated more than 2 cm below the costal margin. In massive splenomegaly, the spleen may be palpated deep into the abdomen, crossing the midline of the abdomen and may even extend into the pelvis. Studies have shown that normal sized spleens may be palpable in approximately 3% of adults.

Patients may have an abnormally palpable spleen with or without exam findings of contributing underlying illness. Patients with splenomegaly due to acute infection may have exam findings consistent with infectious mononucleosis, endocarditis, or malaria. Exam findings of petechiae, abnormal mucosal bleeding, or pallor may accompany hematologic diseases. Jaundice, hepatomegaly, ascites, or spider angiomata may be present in patients with liver disease.  Patients with rheumatologic diseases may present with joint tenderness, swelling, rash, or an abnormal lung exam.

Evaluation

A combination of serum testing and imaging studies may definitively diagnose splenomegaly and the underlying cause. Derangement in the complete blood (cell) counts and morphology including WBC, RBC, and platelets will vary based on the underlying disease state. Abnormalities in liver function tests, lipase, rheumatologic panels, and disease-specific infectious testing aid in the diagnosis of causative disease.[8] Hypersplenism may present with leukopenia, anemia, and thrombocytopenia.

Imaging may be used to diagnose splenomegaly and elucidate its underlying cause. The spleen has a similar attenuation as the liver when measured on CT imaging. In addition to diagnosing splenomegaly (a splenic measurement of greater than 10 cm in craniocaudal length), abdominal CT may detect splenic abscess, mass lesions, vascular abnormalities, cysts, inflammatory changes, traumatic injury, intra-abdominal lymphadenopathy, or liver abnormalities.

Ultrasound is a useful imaging modality in measuring the spleen and spares the patient radiation from CT imaging. Normal spleen size measured via ultrasound is less than 13 cm superior to the inferior axis, 6 cm to 7 cm in medial to lateral axis and 5 cm to 6 cm in anterior to the posterior plane.

MRI, PET scans, liver-spleen colloid scanning, and splenectomy and splenic biopsy may be indicated in certain cases.

Treatment / Management

Treatment of splenomegaly is targeted at treating the underlying disease and protecting the patient from complications of splenomegaly itself.  Patients with splenomegaly from any cause are at increased risk of splenic rupture, and increased attention must be made to protect the patient from abdominal trauma. Treatment ranges from abdominal injury avoidance in the young healthy patient with splenomegaly due to infectious mononucleosis, to splenectomy of a massively enlarged spleen in a patient with hairy cell leukemia. Likewise, the prognosis is largely dependent on the underlying disease state. [9][10]

Splenic sequestration is seen in sickle cell anemia is often managed with blood transfusions/exchange transfusions. Sometimes splenectomy is required for ITP. Low dose radiation therapy can also shrink the spleen size in patients with primary myelofibrosis.

Patients who undergo splenectomy are at increased risk of infections secondary to encapsulated organisms such as Haemophilus Influenzae, Streptococcus pneumoniae, and Neisseria meningitidis. Vaccinations against these organisms are highly recommended in patients who have undergone splenectomy. Careful attention must be paid to post-splenectomy patients presenting with febrile illnesses as they may require more aggressive, empiric antibiotic therapy.

Differential Diagnosis

There are several potential causes of splenomegaly, and careful and thorough evaluation is often needed to find the underlying cause of splenomegaly.

These include:

• Cirrhosis

• Hepatitis

• Rheumatoid arthritis

• Felty syndrome

• Systemic lupus erythematosus

• Lymphoma

• Sickle cell anemia

Liver disease (cirrhosis, hepatitis) is one of the most common causes and history of liver disease, abnormal physical exam findings and elevated liver enzymes in addition to abnormal liver imaging can help diagnose liver diseases.

Hematologic malignancies and metastasis shall be especially considered in patients with constitutional symptoms and weight loss. Abnormal peripheral blood smear and biopsy can assist in diagnosing malignancies.

Autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) frequently are associates with splenomegaly. In RA, the presence of splenomegaly in addition to neutropenia is termed Felty syndrome. 

Acute and chronic infections including viral, bacterial, fungal, and mycobacterial infections can all cause splenomegaly and shall be carefully ruled out.

Cytopenias and diseases causing splenic sequestration can be ruled out by complete blood counts, peripheral blood smear and hemoglobin electrophoresis.

Infiltrative disorders such as glycogen storage diseases are a rare cause of splenomegaly and shall be considered if other more common causes are ruled out in patients with other clinical features consistent with these glycogen storage diseases.

Prognosis

The prognosis for patients with splenomegaly depends on the condition causing the enlargement. Regardless of the underlying etiology, the risk of rupture even with minor trauma is high in patients with an enlarged spleen.

Complications

Splenic rupture is the most feared complication of splenomegaly. Patients are advised to avoid high-impact or contact sports to minimize this risk. Cytopenias due to splenomegaly is another potential complication. Most of these can be minimized with splenectomy if indicated. 

Deterrence and Patient Education

Patients with enlarged spleens are advised to avoid high-impact or contact sports to avoid the risk of splenic rupture. 

Once a patient undergoes splenectomy, they should be advised of the higher risk of infections and proper immunization should take place to minimize this risk. 

Enhancing Healthcare Team Outcomes

Patients with splenomegaly are best managed by an interprofessional team that includes a radiologist, internist, hematologist, oncologist, surgeon, nursing staff and sometimes other specialists such as rheumatologists and gastroenterologists. Due to a high risk of rupture, patient education is crucial, and contact sports shall be avoided in patients with splenomegaly. 

The nursing staff should educate the patient on the risk of infections if they undergo splenectomy. Vaccination against encapsulated organisms is highly recommended prior to the splenectomy.  All patients who have had a splenectomy should wear a medical alert bracelet explaining the absence of a spleen. Antibiotic prophylaxis is recommended in post-splenectomy patients undergoing surgical procedures. Further, careful attention must be paid to post-splenectomy patients presenting with febrile illnesses as they may require more aggressive, empiric antibiotic therapy.

All patients with splenomegaly should be educated about the signs of splenic rupture and when to seek medical assistance. Unlike a normal spleen, an enlarged spleen that has ruptured cannot be managed with observation. Close collaboration with the team members is important to ensure that patients without a spleen have good outcomes.  Most patients have a good outcome after splenectomy.[11][12]

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Radiograph Abdomen Splenomegaly. Contributed by Scott Dulebohn, MD

Figure

CT Splenomegaly. Image courtesy O.Chaigasame

References

1.

Nguyen Y, Stirnemann J, Belmatoug N. [Gaucher disease: A review]. Rev Med Interne. 2019 May;40(5):313-322. [PubMed: 30638965]

2.

Kang DW, Kim SH. Clinical aspects of splenomegaly as a possible predictive factor of coronary artery changes in Kawasaki disease. Cardiol Young. 2019 Mar;29(3):297-302. [PubMed: 30572971]

3.

Gala AR, Surapaneni T, Aziz N, Kallur SD. A Review of Outcomes in Pregnant Women with Portal Hypertension. J Obstet Gynaecol India. 2018 Dec;68(6):447-451. [PMC free article: PMC6207547] [PubMed: 30416270]

4.

Justiz Vaillant AA, Goyal A, Varacallo M. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Feb 27, 2023. Systemic Lupus Erythematosus. [PubMed: 30571026]

5.

Chauhan K, Jandu JS, Brent LH, Al-Dhahir MA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jan 10, 2023. Rheumatoid Arthritis. [PubMed: 28723028]

6.

Palmiere C, Tettamanti C, Scarpelli MP, Tse R. The forensic spleen: Morphological, radiological, and toxicological investigations. Forensic Sci Int. 2018 Oct;291:94-99. [PubMed: 30173072]

7.

Sjoberg BP, Menias CO, Lubner MG, Mellnick VM, Pickhardt PJ. Splenomegaly: A Combined Clinical and Radiologic Approach to the Differential Diagnosis. Gastroenterol Clin North Am. 2018 Sep;47(3):643-666. [PubMed: 30115442]

8.

Allison J, Sunne R, Huntington M. Multifactorial Splenomegaly. S D Med. 2017 Dec;70(12):535-538. [PubMed: 29334440]

9.

Saab S, Brown RS. Management of Thrombocytopenia in Patients with Chronic Liver Disease. Dig Dis Sci. 2019 Oct;64(10):2757-2768. [PubMed: 31011942]

10.

Kado R, McCune WJ. Treatment of primary and secondary immune thrombocytopenia. Curr Opin Rheumatol. 2019 May;31(3):213-222. [PubMed: 30920453]

11.

Vittorio J, Orellana K, Martinez M, Ovchinsky N, Schlossberg P, Griesemer A, Lobritto S. Partial Splenic Embolization Is a Safe and Effective Alternative in the Management of Portal Hypertension in Children. J Pediatr Gastroenterol Nutr. 2019 Jun;68(6):793-798. [PubMed: 30908386]

12.

Ashorobi D, Fernandez R. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Nov 12, 2022. Asplenia. [PubMed: 30844198]

Disclosure: Jennifer Chapman declares no relevant financial relationships with ineligible companies.

Disclosure: Amandeep Goyal declares no relevant financial relationships with ineligible companies.

Disclosure: Alexandre Azevedo declares no relevant financial relationships with ineligible companies.

Spleen problems and spleen removal

Some people are born without a spleen or need to have it removed because of disease or injury.

The spleen is a fist-sized organ found 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 a few important functions.

It fights any invading germs in the blood (the spleen contains infection-fighting white blood cells).

It controls the level of blood cells. The spleen controls the level of white blood cells, red blood cells and platelets (small cells that form blood clots).

It screens the blood and removes any old or damaged red blood cells.

If the spleen doesn’t 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, from a reduced number of platelets

Spleen problems

Spleen pain

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 rupture (burst) after a forceful blow to the abdomen, car accident, sporting accident or fracture to the 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, the pain can be felt at the tip of your left shoulder.

A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding.

Immediate action required:

Go straight to A&E if:

• you think you’ve ruptured or damaged your spleen

Enlarged spleen

The spleen can become swollen after an infection or injury. It can also become enlarged as a result of a disease such as cirrhosis, leukaemia or rheumatoid arthritis.

An enlarged spleen doesn’t 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/or 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 would 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. Antibiotics may be prescribed 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 is enlarged.

Surgery is only necessary if the enlarged spleen is causing serious complications or if the cause can’t be found.

Splenectomy (having the spleen removed)

An operation to remove the spleen, known as a splenectomy, may be needed if the spleen is damaged, diseased or enlarged.

It may sometimes be more appropriate to have just part of your spleen removed – a partial splenectomy.

If there’s time, you’ll be advised to have a series of immunisations before the operation.

Laparoscopy

Most splenectomies are carried out using laparoscopy (keyhole surgery).

A laparoscope is long, thin, flexible instrument with its own light source. It is attached to a camera and will relay high definition, magnified pictures back to a TV screen to guide the surgeon’s instruments.

Laparoscopic splenectomy allows a surgeon to access the inside of your abdomen without having to make large incisions (cuts) in your skin. However, you will still need a general anaesthetic.

The procedure involves:

• making several incisions in your abdomen (tummy area)
• guiding a laparoscope into your body through one of the incisions, so doctors can see what they’re doing
• passing thin instruments into your abdomen through the other incisions, to remove your spleen – gas will be pumped into your abdomen to make this easier

The incisions will then be stitched up or sometimes glued together.  You may be able to go home the same day, or 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, where one large incision is made, may be needed if the spleen is too large or too damaged to be removed via keyhole surgery. Often, in emergencies, this will be the preferred method to rapidly control bleeding.

You’ll need a general anaesthetic and may need to stay in hospital for a few days to recover.

Afterwards

It’s normal to feel sore and be bruised after a splenectomy, but you’ll be given pain relief medication.

You should be able to eat and drink as normal soon after the operation.

Like any operation, a splenectomy carries a small risk of complications, including bleeding and infection.

Your doctor will run through these risks with you.

You should be given breathing and leg movement 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 will still be able to cope with most infections. However, there is a small risk that a serious infection may develop quickly. This risk will be present for the rest of your life.

Risk of infection

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 medical condition such as sickle cell anaemia, coeliac disease or a condition that affects your immune system, such as HIV.

This risk can be minimised by following simple precautions to prevent infection.

Vaccinations

Read about vaccinations for children and adults without a fully working spleen.

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 doesn’t work properly

Be alert for signs of infection

Watch out for signs of infection, such as:

• high temperature (fever)
• sore throat 
• cough
• severe headache 
• 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. You should start taking them at the first sign of an infection, so see your GP as soon as possible.

If your infection becomes serious, you will be admitted to hospital.

Animal and tick bites

Bites from animals and ticks (small blood-sucking parasites) can cause infections.

If you get bitten by an animal, particularly a dog, start your course of antibiotics and seek medical advice urgently.

If you go trekking or camping regularly, you may be at risk of babesiosis, which is a rare disease transmitted by ticks. Try to avoid tick bites by wearing clothes that cover your skin, particularly long trousers. If you become ill, get medical advice straight away.

Telling medical staff about your condition

Healthcare professionals will mark your health records to show that you don’t have a working spleen. However, always remember to tell any medical professionals that you see, including your dentist.

Carry medical ID

It’s a good idea to carry or wear some medical ID. For example:

• if your spleen is removed, the hospital may give you a splenectomy card to take home with you
• you may want to buy your own medical ID, such as a MedicAlert or Medi-Tag bracelet or pendant 

If you need help or emergency treatment, your medical ID will alert the staff to your condition.

Travel abroad

Read advice about travelling abroad without a fully working spleen.

Scars

The scars from your operation will gradually fade.

Last updated:

29 May 2023

How can we improve this page?

Help us improve NHS inform

Don’t include personal information e.g. name, location or any personal health conditions.

Email Address

e. g. [email protected]

Message

Maximum of 500 characters

Biologists have turned the spleen into a liver inside a live mouse

Chinese biologists have developed a method that allows you to turn one organ into another, that is, to grow the liver on the scaffold of the spleen. rusjev.net writes about this.

“The easiest way to cope with a liver failure is to transplant a new one to a patient. However, it is far from always possible to find a donor in time, and the organ itself after transplantation may not take root or not work in full,” the message says.

A group of biologists led by Lei Dong from the University of Nanjing proposed an alternative approach to the problem: to grow a new organ right inside the patient’s body. And the vascular framework, according to their idea, can be borrowed from some other organ that is not vital. In the case of the liver, the spleen could become such an organ: it is quite large, well supplied with blood, but not critical for life. People with a removed spleen do not suffer from serious illnesses, so it could be donated in favor of the liver.

Read also

Medical breakthrough: scientists grow human ears on the backs of mice

First, the researchers pushed the spleen of experimental mice under the skin to make it easier to track its condition. They checked that after the transfer, the organ retained its size and morphology, and its cells produced a standard set of spleen proteins.

After that, the first stage of transformation of the spleen began. In order for a full-fledged liver to grow in it, it was necessary to prepare it: reduce the activity of immunity and allow newly arrived cells to divide. To do this, biologists decided to treat the spleen with an extract of a mouse tumor.

Biologists have found that under the influence of sarcoma extract, the spleen under the skin of the mouse grows strongly and begins to weigh almost twice as much as usual. At the same time, this transformation, according to the authors of the work, did not affect the health of the mice themselves and the work of other organs.

At the second stage of transformation, the spleen had to be populated with liver cells. The researchers tested four types of cells: a mouse’s own liver cells, liver cells from another mouse, human liver cells, and liver cells grown from reprogrammed human cells. All of them took root in the spleen after treatment with the tumor extract and remained there for two weeks after the extract was stopped (and the liver’s own cells remained in the spleen even longer). At the same time, mouse liver cells were able to occupy a significant part of the organ and form there structures characteristic of the liver, including the bile ducts.

Finally, the authors of the work checked how the transformed spleen performs the functions of the liver. It turned out that it synthesizes fats, stores glycogen and produces blood proteins, as the liver is supposed to do. Moreover, when 90 percent of the real liver was removed from such animals, they all survived, while from the control group (those who received cells into the unprepared spleen or, conversely, prepared it, but did not introduce the cells), no one survived the removal. liver.

The transformed mouse spleen (left) is much larger than normal (right).

Thus, the researchers found that a good replacement for the liver can be obtained from the spleen. And this procedure does not cause serious side effects – at least in mice. However, the authors of the work note that the transformed spleen has an important difference from the liver – a source of blood. The liver receives blood from the intestines through the portal vein, so signal substances secreted by the intestinal wall may be present in it, and the oxygen concentration is lower. At the next stage of work, it is important to check that the absence of these signals and the unusually high level of oxygen in the blood do not destroy the liver cells at the new place of residence.

Earlier, we wrote about the first transplantation of a grown human liver into an animal.

Infectious mononucleosis: symptoms, treatment, diagnosis, classification

Infectious mononucleosis is an acute manifestation of a viral disease that clinically affects the oral region, pharynx, spleen, liver, and lymph nodes. The provocateur of its occurrence is the Epstein-Barr herpesvirus, which occurs both in adults and among children.

The prevalence of the disease does not depend on the season or gender of the person. However, researchers have identified a pattern: in adolescents going through puberty, the disease is detected more often.

Root causes

There is only one cause of infectious mononucleosis – the Epstein-Barr virus. They can become infected after contact with a sick person. Since the particles of the virus are stored in the saliva of the carrier, the main method of its transmission is airborne.

You can catch the virus by using some household items with an infected carrier. Often transmission occurs sexually, as well as through kissing, unwashed hands, dishes, etc.

In some cases, the virus is transmitted at the time of blood transfusion, as well as from mother to baby during the gestation period.

The most susceptible to the disease are people with a weakened immune system, an acute lack of adequate sleep and a balanced diet.

Symptoms of disease

Symptoms of infectious mononucleosis do not appear immediately: the incubation period can range from 5 to 45 days. In some cases, the patient may notice the following primary symptoms:

• general physical indisposition;
• weakness in the body, prostration;
• mild nasal congestion.

Gradually, the manifestations increase their intensity, the following symptoms are added to them:

• increase in body temperature to the mark on the thermometer of 37.6 degrees;
• sore throat;
• enlarged tonsils, lymph nodes.

After a while, the patient notices:

• severe fever;
• headache;
• body aches;
• acute pain in the throat at the time of swallowing.

If you consult a doctor, he may pay attention to an increase in the size of the spleen and liver and symptoms of follicular, catarrhal or ulcerative necrotic angina. These include an increase in the tonsils, a yellowish coating on the walls of the pharynx, and slight bleeding is possible.

Infectious mononucleosis in children is similar in its manifestations to this disease in adults, differing only in an increased rate of development.

After the liver and spleen increase, they immediately signal this by yellowing of the eye sclera and skin, as well as by the darker color of the patient’s urine. Skin rashes may be observed, accompanied by mild itching.

Possible complications

Infectious mononucleosis in adults and especially children cannot be ignored, as it is fraught with complications:

• remaining in the patient’s body, the virus periodically gives a relapse of the disease;
• there is a high probability of developing an infection – streptococcal or staphylococcal. Once in a weakened body, bacteria provide a particularly aggressive manifestation;
• meningoencephalitis – a serious neurological disease affecting the cerebral substance of the brain;
• enlarged tonsils can cause difficulty in breathing and obstruction of the upper respiratory tract;
• As a complication of infectious mononucleosis in children, hepatitis, lung infiltration are possible;
• thrombocytopenia – in extremely rare cases.

Diagnosis of disease

Diagnosis of infectious mononucleosis is very extensive. After examining the patient, the therapist, infectious disease specialist or pediatrician (in children) prescribes a general blood test. In it, the presence of an ailment is indicated by weak leukocytosis and a shift in the leukocyte formula to the left.

Atypical mononuclear cells are found in the blood. By the way, it is because of them that the patient is recommended to undergo a serological examination three times at certain intervals, since these substances are also characteristic of HIV infection.

Additionally, PCR is given to determine the Epstein-Barr virus and its activity in the patient’s body. M-immunoglobulins can be additionally found.

In infectious mononucleosis with characteristic signs of angina, an additional examination by an otolaryngologist is recommended.

Treatment of disease

Depending on the nature of the course, the treatment of infectious mononucleosis can take place in a hospital or at home. The patient is supposed to comply with bed rest, and in some cases – also a special diet.

The complex of treatment is aimed at removing the intoxication of the body, symptoms, bringing it to a stable state. Along with this, vitamin therapy is prescribed (quality nutrition, vitamin complexes by age).

Severe cases of infectious mononucleosis with pronounced necrotizing processes require the participation of antibiotics. If there is a rupture of the spleen, then its complete removal is urgently carried out.

Preventive measures

If the disease passes without serious complications and under the supervision of a doctor, the prognosis is favorable. After recovery during the year, it is recommended to take a general blood test and an analysis to determine the activity of the Epstein-Barr virus several times.

Other measures to prevent infectious mononucleosis include:

• rational hardening;
• taking vitamin complexes in the autumn-winter period;
• long walks in the fresh air;
• moderate physical activity;
• thorough disinfection of all personal belongings and rooms in which the sick person was.