Showing posts with label spleen. Show all posts
Showing posts with label spleen. Show all posts

Just For Fun - What Does the Spleen Do?

By Alvin Powell, Harvard Staff Writer

Who knew the spleen was so funny? And popular?
A parody video by a group of Harvard Medical School students went viral in December, garnering a million YouTube hits in just five days and surpassing 1.7 million since.
The video’s creators were astounded at its popularity, according to Ben Rome, a second-year student who filmed and edited the video. Rather than just basking in their 15 minutes of fame, however, the students are trying leverage the video’s popularity for a good cause: science education. They launched the HMS/HSDM Organ Challenge, a contest for primary and secondary school students to create a music video highlighting one of the body’s organs.

Read more here............

Spleen stiffness evaluated portal hypertension, indicated esophageal varices in cirrhosis patients

Spleen stiffness evaluated portal hypertension, indicated esophageal varices in cirrhosis patients

Colecchia A. Gastroenterology. 2012;143:646-654.

September 7, 2012

Results from a recent study suggest that measurement of spleen stiffness can be a noninvasive method of assessing portal hypertension and detecting esophageal varices in patients with HCV-induced cirrhosis.

Researchers evaluated the spleen stiffness (SS) and liver stiffness (LS) in 100 patients with HCV-induced cirrhosis. SS was measured via transient elastography (TE), and the effectiveness of this parameter in diagnosing portal hypertension (PH) and esophageal varices (EV) within the cohort was compared with LS and other noninvasive methods, including the LS-spleen diameter to platelet ratio score (LSPS) and the platelet count to spleen diameter ratio (Plt/Spl).

Esophageal varices were present in 53 participants, including 27 with grade I, 20 with grade II and six with grade III. All patients had hepatic vein pressure gradients (HVPG) of more than 5 mm Hg. Clinically significant portal hypertension was present in 65 patients, with 54 cases considered severe (12 mm Hg or greater).

SS measurements were significantly higher in patients with EV compared with those without (58.6 kPa vs. 39 kPa), and among those with clinically significant PH compared with those with preclinical hypertension (n=35) (56 kPa vs. 37 kPa). Investigators observed correlations between results from different testing methods and HVPG, with the strongest between HVPG and SS (r=0.885) and LS (r=0.836) (P=.0001 for both), and found that the best predictive model for HVPG included both LS and SS (R2=0.85, P<.0001).

AUROC analysis indicated significant differences between SS and other evaluated tests in diagnosing the following:

  • Presence of EV: AUROC=0.941 for SS compared with 0.857 for Plt/Spl (P=.05)
  • HVPG of 10 mm Hg or higher: AUROC=0.966 for SS compared with 0.907 for LSPS (P=.05) and with 0.847 for Plt/Spl (P=.007)
  • HVPG of 12 mm Hg or higher: AUROC=0.959 for SS compared with 0.899 for LSPS (P=.048) and with 0.828 for Plt/Spl (P=.003)
No significant difference was observed between SS and LS in the AUROC for any diagnoses.
“The results of the present study provide advancement and a wide insight into the relevant diagnostic potential of TE in the clinical setting of HCV-induced cirrhosis,” the researchers wrote. “In particular, they suggest for the first time that introduction of SS measurement, possibly associated with LS, may enable clinicians to monitor the evolution of PH from early to late cirrhosis, including the occurrence of EV.”

Hepatitis C News Ticker-Following response-guided therapy guidelines with boceprevir and telaprevir

"Reading the Paper" Lynne Crumpacker

Hepatitis Journal Options – Volume 5, Issue 1

This special edition includes all the pivotal phase III studies of the HCV protease inhibitors, with a range of commentaries exploring key aspects of the use of these agents, plus Capsule Summaries of each study and downloadable slidesets.

Topics include:

Now Available! CCO Hepatology inPractice™

  • Following response-guided therapy guidelines with boceprevir and telaprevir
  • Understanding futility rules and their importance
  • Outcomes and management of anemia
  • Strategies for managing telaprevir rash and anorectal symptoms
  • Using boceprevir and telaprevir in patients with advanced fibrosis or cirrhosis
  • Effect of telaprevir on cyclosporine and tacrolimus pharmacokinetics
  • Antiviral activity with telaprevir in patients with genotype 2 or 3 HCV
  • Evaluation of HBV screening cost effectiveness
*Free Registration Required-Register Here

Treatment of chronic hepatitis C virus infection. A study of best predictors for response.

Ospina N, Rodríguez JL, Hernández M, García C, Martín JM, Redondo E, Olivia L, Pena MJ.

PDF in Spanish -Translate here

María José Pena López, Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, C/Barranco de la Ballena s/n, 35020 Las Palmas de Gran Canaria, Spain.



The aim of this study was evaluate the rate of sustained viral response (SVR) and the influence of different factors on the SVR in patients with chronic hepatitis C virus (HCV) infection treated with pegylated interferon alfa 2a and ribavirin. Methods: We retrospectively analysed 272 naïve patients with chronic hepatitis C who had been treated for 24 weeks or 48 weeks and had been followed for an additional 6 months thereafter.


Out of 272 patients, 243 completed the entire treatment. The overall SVR rate in intent-to-treat analysis was 66.5% and in treated patients was 74.5%. In an univariate analysis, the SVR was associated with age <40 years (84.4%),pre-treatment viral load <500.000 IU/ml (86.9%), non-1 genotype HCV (86.4%), non cirrhosis or pre-cirrhosis (76.5%), rapid virologic response (RVR) (91.4%) and early virologic response (EVR) (83.8%).

In the multivariate logistic regression analysis, the presence of an infection caused by a non-1 genotype and to achieve ERV were independent predictors of SVR. The RVR and histological stage of liver disease were not included in the multivariate analysis because these data were not available in most of the patients. The PPV and NVP of RVR were 91.5% and 48.7% respectively, of EVR were 83.8% and 95.8% respectively and of complete EVR were 91.3% and 78.7%, respectively. Conclusions: The SVR was higher than in other studies. The genotype and EVR were independent factors to predict the effect of antiviral therapy. The EVR had a high NPV and the complete EVR a high PPV.

Research article

Arsenic, vinyl chloride, viral hepatitis, and hepatic angiosarcoma: A hospital-based study and review of literature in Taiwan

Neng-Chyan Huang, Shue-Ren Wann, Hong-Tai Chang, Shoa-Lin Lin, Jyh-Seng Wang and How-Ran Guo View PDF BMC Gastroenterology 2011, 11:142 doi:10.1186/1471-230X-11-142 Published: 26 December 2011

Abstract (provisional)

View PDF.

Hepatic angiosarcoma (HAS) is a rare type of liver cancer that is often fatal, and arsenic and vinyl chloride monomer (VCM) are two major causal agents. Whereas Taiwan is an endemic area of liver cancer, epidemiologic data on HAS are limited. We reviewed the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic, and viral hepatitis in the occurrence of HAS.

We reviewed the medical records of patients with pathological proof of HAS from January 2000 to December 2010 at a teaching hospital which is adjacent to the major VCM processing area in Taiwan and nearby an endemic area of arsenic exposure from drinking water. We also conducted a literature review and included all patients of HAS reported in Taiwan.

Six male and three female cases aged from 50 to 82 years (64.1 +/- 9.1 years) were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6 +/- 15.5 years) were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection.

HAS is rare in Taiwan, and we found no evidence supporting a major role of VCM, arsenic in drinking water, or viral hepatitis in its occurrence.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.


Tyzeka (telbivudine) labeling updates re: use with pegylated interferon alfa-2a
On December 23, 2011, the Food and Drug Administration approved revisions to the product labeling for Tyzeka (telbivudine) to include a contraindication regarding the use of Tyzeka with Pegasys (pegylated interferon alfa-2a) due to increase risk and severity of peripheral neuropathy. The Medication Guide was also revised accordingly. The following sections were revised:


Combination of Tyzeka with pegylated interferon alfa-2a is contraindicated because of increased risk of peripheral neuropathy

Warnings and Precautions

Peripheral Neuropathy
Peripheral neuropathy has been reported with Tyzeka alone or in combination with pegylated interferon alfa-2a and other interferons. In one clinical trial, an increased risk and severity of peripheral neuropathy was observed with the combination use of Tyzeka 600mg daily and pegylated interferon alfa-2a 180 micrograms once weekly compared to Tyzeka or pegylated interferon alfa-2a alone [see Contraindications (4) and Drug Interactions (7)]. Such risk cannot be excluded for other dose regimens of pegylated interferon alfa-2a, or other alfa interferons (pegylated or standard). The safety and efficacy of Tyzeka in combination with pegylated interferons or other interferons for the treatment of chronic hepatitis B has not been demonstrated. Patients should be advised to report any numbness, tingling, and/or burning sensations in the arms and/or legs, with or without gait disturbance. Tyzeka therapy should be interrupted if peripheral neuropathy is suspected, and discontinued if peripheral neuropathy is confirmed

Drug Interactions:

A clinical trial investigating the combination of Tyzeka, 600 mg daily, with pegylated interferon alfa-2a, 180 micrograms once weekly by subcutaneous administration, indicates that this combination is associated with an increased risk of peripheral neuropathy occurrence and severity, in comparison to Tyzeka or pegylated interferon alfa-2a alone

Richard Klein
Office of Special Health Issues
Food and Drug Administration

Kimberly Struble
Division of Antiviral Drug Products
Food and Drug Administration

Big Pharma

Causes are hard. Explaining pharma’s problems is harder

We all know the pharmaceutical industry is in trouble — what, with the precipitous patent cliff, soaring price of drug development and the death of the megablockbuster. And much ink has been spilled about the potential solutions to pharma’s problems, from mergers to academic partnerships to new research units. But what if the entire R&D enterprise is fundamentally flawed?

That’s the hypothesis of a new article in Wired magazine by science writer Jonah Lehrer postulating that the reductionist dogma of modern biomedicine has prompted scientists to desperately seek causal narratives where there are only statistical correlations to be found. In turn, Lehrer’s theory goes, such causal stories that scientists tell themselves have led drug developers on expensive and ultimately futile pharmaceutical goose chases.

Read more


Discovered the existence of neutrophils in the spleen
These neutrophils are there without there being any infection and play an immunoregulating role

This release is available in Spanish.
Barcelona, 23rd of December 2011.- For the first time, it has been discovered that neutrophils exist in the spleen without there being an infection. This important finding made by the research group on the Biology of B Cells of IMIM (Hospital del Mar Research Institute) in collaboration with researchers from Mount Sinai in New York, has also made it possible to determine that these neutrophils have an immunoregulating role.

Neutrophils are the so-called cleaning cells, since they are the first cells to migrate to a place with an infection and inflammation to destroy the pathogens. Until now, scientific literature had considered neutrophils essentially as lowly qualified soldiers that simply limited the expansion of an infection, as a first action to pave the way for other cells of the immune system in charge of eradicating the infection permanently.

"This study has revealed that neutrophils are found in the spleen without there being an infection, contributing totally new knowledge in the field of biology" explains Andrea Cerutti, the coordinator of the research group on the Biology of B Cells of IMIM, a professor at ICREA and the last signatory of the article.

Researchers noticed that the existence of neutrophils in the spleen started when the fetus is developing, even when there is no infectious process involved; this was not known in scientific literature. The study was expanded to people of different ages and other mammals. Detecting the presence of neutrophils in the spleen suggested that these played a different role in the spleen to the one usually given to them.

The neutrophils in the spleen are located around B lymphocytes to help their activation and offer a first rapid response when there are pathogens. "through several different experimental approaches we have proven that neutrophils in the spleen acquire the ability to interact with B cells or B lymphocytes, inducing the production of antibodies, a role that lymphocytes circulating in blood are not able to do" states Irene Puga, researcher of the IMIM and a signatory of this article.

This finding improves the understanding of the mechanisms with which our immune system protects us against an infection, an essential requirement to better control all pathologies linked to it. Also, when faced with certain diseases, such as neutropenia (or a numeric deficiency of neutrophils), it will become necessary to study not only the deficiency of neturophils, but also how this affects the production of antibodies.

This work opens the door to therapies which are geared at, and more affective against, different pathogens, for example, to develop vaccines to increase the capacity of neutrophils in the spleen so as to have an incidence on the production of antibodies by type B lymphocytes.


This study has been made possible thanks to the simples gathered mainly in different Catalan hospitals such as Hospital del Mar, Hospital Clínic, Hospital de la Vall d'Hebron and Hospital Sant Joan de Déu, together with other centres in the USA and Europe.

Reference article

"B–helper neutrophils stimulate immunoglobulin diversification and production in the marginal zone of the spleen" Irene Puga, Montserrat Cols, Carolina Barra, Bing He, Linda Cassis, Maurizio Gentile, Laura Comerma, Alejo Chorny, Meimei Shan, Weifeng Xu, Giuliana Magri, Daniel M.Knowles, Wayne Tam, April Chiu, James B Bussel, Sergi Serrano, José Antonio Lorente,Beatriz Bellosillo, Josep Lloreta, Nuria Juanpere, Francesc Alameda, Teresa Baró, Cristina Díaz de Heredia, Núria Torán, Albert Català, Montserrat Torrebadell, Claudia Fortuny,Victoria Cusi, Carmen Carreras, George A. Diaz, J. Magarian Blander, Claire-Michèle Farber, Guido Silvestri, Charlotte Cunningham-Rundles, Michaela Calvillo, Carlo Dufour, Lucia Dora Notarangelo, Vassilios Lougaris, Alessandro Plebani, Jean-Laurent Casanova, Stephanie C. Ganal, Andreas Diefenbach, Juan Ignacio Aróstegui, Manel Juan, Jordi Yagüe, Nizar Mahlaoui, Jean Donadieu, Kang Chen & Andrea Cerutti. Nature Immunology 2011

For further information

Rosa Manaut, head of communications at IMIM, Tel: +34 618 509 885 or Marta Calsina, Communication service at IMIM, Tel: +34 933 16 06 80.


Active Compounds in 'Bath Salts' and Ecstasy Similar

December 20, 2011 — Mephedrone and methylone, which are the active compounds found in so-called "bath salts," have mechanisms of action similar to those found in 3,4-methylenedioxymethamphetamine (MDMA), popularly known as ecstasy — a finding that may explain the product's potential for addiction, new research suggests.

Investigators found that these compounds bind to monoamine transporters on the surface of some neurons, leading to an increase in both serotonin and, to a lesser degree, dopamine.

"Dopaminergic effects of mephedrone and methylone may contribute to their addictive potential, but this hypothesis awaits confirmation," write lead author Michael H. Baumann, PhD, from the Translational Pharmacology Section and Intramural Research Program at the National Institute on Drug Abuse (NIDA) in Baltimore, Maryland, and colleagues.

In a message posted on NIDA's Web site, Nora Volkow, MD, director of NIDA, notes that because "bath salts" are a product that is "relatively new to the drug abuse scene," knowledge about their precise chemical composition and effects is limited.

"The information we do have is worrisome and warrants a proactive stance to understand and minimize any potential dangers to the health of the public," writes Dr. Volkow.

"Mephedrone is of particular concern because, according to the United Kingdom experience, it presents a high risk for overdose. These chemicals act in the brain like stimulant drugs (indeed they are sometimes touted as cocaine substitutes); thus they present a high abuse and addiction liability," she adds.

The study was published online December 14 in Neuropsychopharmacology.

Caution Urged

"The nonmedical use of 'designer' cathinone analogs, such as 4-methylmethcathinone (mephedrone) and 3,4-methylenedioxymethcathinone (methylone), is increasing worldwide," write the investigators.

However, there is little information available on their mechanism of action.

For this study, the researchers examined rats to compare neurological effects after the administration of mephedrone or methylone with the effects after receiving 3,4-metlhylenedioxymethamphetamine (MDMA, or ecstasy) or methamphetamine.

In vitro release assays from the rat brains showed that both mephedrone and methylone "are nonselective substrates for plasma membrane monoamine transporters, similar to MDMA in potency and selectivity," report the investigators.

In vivo microdialysis of the rats' nucleus accumbens showed that mephedrone and methylone produced dose-related increases in extracellular dopamine, and even greater increases in serotonin.

The peak magnitude of dopamine increase was 1.8-fold above baseline after doses of 0.3 mg/kg of mephedrone were given and 2.9-fold after doses of 1.0 mg/kg were given. The peak magnitude of serotonin increase was 4.2-fold and 11.1 fold, respectively.

For methylone, the peak magnitude of dopamine increase was 1.7-fold above baseline after doses of 1.0 mg/kg were given. For serotonin, it was 6.3-fold above baseline.

Nevertheless, both mephedrone and methylone were considered weaker motor stimulants than methamphetamine.

Repeated high-dose administration of mephedrone or methylone led to hyperthermia but no "long-term change in cortical or striatal amines." On the other hand, extended doses of MDMA let to "robust" hyperthermia and persistent depletion of cortical and striatal serotonin.

"Given the widespread use of mephedrone and methylone, determining the consequences of repeated drug exposure warrants further study," write the researchers.

"In the meantime, I would like to urge parents, teachers, and the public at large to be aware of the potential dangers associated with the use of these drugs and to exercise a judicious level of vigilance that will help us deal with this problem most effectively," writes Dr. Volkow.

The study was supported by grants from NIDA and from the Retina Research Foundation/UW Eye Research Institute Edwin and Dorothy Gamewell Professorship. Dr. Baumann has disclosed no relevant financial relationships.

Neuropsychopharmacology. Published online December 14, 2011.


Deborah Brauser

is a freelance writer for Medscape.

Deborah Brauser has disclosed no relevant financial relationships.

HCV Awareness

According to available data 6.7% of Georgia's adult population close to (200 000 people) are infected with Hepatitis C virus. The prevalence level is two-times higher than World's average. Absence of statistical data and effective state policy in relation to Hepatitis C deepens the epidemic. Hepatitis C can cause liver decease including liver cirrhosis and cancer.

Advanced Liver Disease: What Every Hepatitis C Virus Treater Should Know

Advanced Liver Disease Volume 19 Issue 3 August/September 2011

Please click below to listen to podcast and view text.

Advanced Liver Disease: What Every Hepatitis C Virus Treater Should Know

Audio Will Include Moments Of Hesitation/Silence During Podcast.....

Patients with advanced fibrosis need to be regularly monitored for evidence of decompensated disease, and complications need to be aggressively managed.....

This article summarizes a presentation by Kenneth E. Sherman, MD, at the IAS–USA live continuing medical education course, Management of Hepatitis C Virus in the New Era, held in New York City in April 2011.

Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used

New Chronic Hepatitis Study Findings Reported from H. Stefanescu and Co-Authors


According to recent research from Romania, "Splenomegaly in a common finding in liver cirrhosis that should determine changes in the spleen's density because of portal and splenic congestion and/or because of tissue hyperplasia and fibrosis. These changes might be quantified by elastography, so the aim of the study was to investigate whether spleen stiffness measured by transient elastography varies as liver disease progresses and whether this would be a suitable method for the noninvasive evaluation of the presence of esophageal varices."

"One hundred and ninety-one patients (135 liver cirrhosis, 39 chronic hepatitis and 17 healthy controls) were evaluated by transient elastography for measurements of spleen and liver stiffness. Cirrhotic patients also underwent upper endoscopy for the diagnosis of esophageal varices. Spleen stiffness showed higher values in liver cirrhosis patients as compared with chronic hepatitis and with controls: 60.96 vs 34.49 vs 22.01 KPa (P Chronic Hepatitis).

The researchers concluded: "Esophageal varices' presence can be better predicted if both spleen and liver stiffness measurements are used."

Stefanescu and colleagues published their study in the Journal of Gastroenterology and Hepatology (Spleen stiffness measurement using fibroscan for the noninvasive assessment of esophageal varices in liver cirrhosis patients. Journal of Gastroenterology and Hepatology, 2011;26(1):164-170).

For additional information, contact H. Stefanescu, Iuliu Hatieganu University of Medicine & Pharmacy, Medical Clinic 3, 19-21 Croitorilor St., Cluj Napoca 400162, Romania.

Publisher contact information for the Journal of Gastroenterology and Hepatology is: Wiley-Blackwell Publishing, Inc., Commerce Place, 350 Main St., Malden 02148, MA, USA.

Keywords: Country:Romania, Chronic Hepatitis, Digestive System Diseases, Fibrosis, Gastroenterology, Hemic and Immune Systems, Hepatology, Human, Immunology, Infectious Disease, Liver Cirrhosis, Liver Diseases, Spleen, Varicose Vein

This article was prepared by Gastroenterology Week editors from staff and other reports. Copyright 2011, Gastroenterology Week via

To see more of the, or to subscribe, go to .

Facts About Decompensated Liver Disease

Facts About Decompensated Liver Disease

In order to understand what happens in decompensated liver disease, you need to understand some of the many functions of the liver and what happens in liver disease. Decompensated when used in this way, really means unstable. Someone can have liver disease for many years, and while they may not be in great health, they are not in immediate risk of liver failure.

This liver is the only organ that has the ability to regenerate itself after it is injured in some way. When the liver is injured repeatedly, but still regenerates, it becomes fibrous in texture. When enough damage has occurred and the liver can no longer repair itself, that is called cirrhosis. At that point, the liver damage is permanent.

The liver makes bile. Bile is necessary to break down fats and therefore a healthy liver is needed for the body to be able to use fat soluble vitamins. The fat soluble vitamins that doctors worry about are A, D, E, and K. Most people with compensated, or stable, liver disease will take supplements of those vitamins in order to avoid deficiencies.

Another major function of the liver is to clean the blood. Blood flows from the spleen through the portal vein to the liver. It then profuses through the liver like water goes through a sponge.
If the liver is cirrhotic, it will be too hard and the blood can’t go through it as fast as the body needs. The main chemical that builds up in the blood that causes problems for people is ammonia.
A person with too much ammonia in their blood will become, lethargic and confused and this can even lead to coma. This is called hepatic encephalitis (Encephalopathy)
Dr. Johnson provides commentary on minimal hepatic encephalopathy
Do patients with minimal hepatic encephalopathy have insight into their impaired
driving skills?
Portal Hypertension

Another complication of the blood not being able to adequately flow through the portal vein and through the liver (called portal hypertension) is an enlarged spleen. In itself, an enlarged spleen is not a large concern, but as the spleen enlarges it tends to attract platelets and white blood cells. This, and the vitamin K deficiency, will cause the blood to not be adequately able to clot. It also causes the immune system to be compromised.
. .

The human body is an amazing thing and will always try to find a way to make things work. When a person with liver disease has portal hypertension the blood backs up into the spleen. The spleen can only handle so much, but the pressure is still in the portal vein.
That’s when the body creates new veins to carry the blood.
These are called varices.

These veins can be seen on the stomach of someone with severe portal hypertension. They seem to radiate from the belly button and are called caput medusai, because they look the Medusa’s hair. Varices become a concern because they tend to rupture and bleed. The varices that are most likely to bleed are the ones surrounding the esophagus. A bleed of this sort can be massive and life threatening.

Decompensated liver disease is when any of these complications become a problem, or when the complications begin to deteriorate at a fast rate. Many people live with cirrhosis and portal hypertension for years at a time. When a person has decompensated liver disease, the only available medical intervention is a liver transplant. In most cases this will be a cure and many of the complications will disappear. Unfortunately not everyone that is listed for a liver transplant receives an organ in time.

;Also see: Cirrhosis: What Happens When The Spleen Is Enlarged ?

Cirrhosis: What Happens When The Spleen Is Enlarged ?

Some patients with cirrhosis have enlarged livers and/or spleens.
The obstructed flow of blood through the portal vein (portal hypertension) causes the spleen to enlarge by causing an increase in pressure inside the vessels of the spleen. The spleen stores red and white blood cells and platelets (fragment of cells that are used to clot blood). An enlarged spleen traps platelets lowering levels in the blood which can lead to the inability of blood to clot. This is called Thrombocytopenia and is common in people with cirrhosis. Thrombocytopenia or thrombopenia in short is the presence of relatively few platelets in blood. Generally speaking, in human beings a normal platelet count ranges from 750,000 to 800,000 platelets per microliter of blood. These limits are determined by the 2.5th lower and upper percentile, so values outside this range do not necessarily indicate disease. One common definition of thrombocytopenia is a platelet count below 50,000 per microliter

A doctor can often feel (palpate) the lower edge of an enlarged liver below the right rib cage and feel the tip of the enlarged spleen below the left rib cage. However, x-rays and other imaging tests may be used to determine how large the spleen is. A cirrhotic liver also feels firmer and more irregular than a normal liver.
Q- What happens when the spleen is enlarged ?
Spleen is an important organ of the lymphatic system. It is found on the left upper side of the abdomen, between the 9th and 12th rib. The primary function of the spleen is to produce lymphocytes and plasma cells, which are used in humoral and cellular immune defense. Approximately half of the body’s monocytes are stored in this organ. These cells can easily transform into macrophages and dendritic cells, and assist in wound repair. Additionally, the spleen filters the blood and removes all the unwanted materials like cell debris and microorganisms as bacteria, viruses and fungi.

Furthermore, it monitors the red blood cells, eliminating those that are abnormal, damaged or too old to function properly. It also serves as a storehouse for various elements of the blood like platelets and white blood cells. In the absence of the spleen, the body becomes susceptible to diseases caused by bacteria and protozoa, and responsiveness to certain vaccines also decreases.Whenever the normal functioning of the body is hampered by disorders like cancer, anemia, malaria, tuberculosis, amyloidosis, cirrhosis, hepatitis and the like, the spleen becomes hyperactive, and starts entrapping and storing a large number of blood cells and platelets.

As the result, the platelet and blood cell count in the bloodstream begins to fall dramatically. Due to entrapment, the spleen grows in size, and as it grows, it traps in more and more blood cells and platelets. Eventually the overgrown spleen starts capturing and destroying the normal blood cells together with the abnormal ones. These blood cells and platelets clog the spleen and interfere with its normal function.

The characteristic symptom of spleen enlargement is severe pain in the abdomen and back. At times, the pain shoots up to the left shoulder. This happens when certain parts of the spleen begin to bleed and die due to inadequate supply of blood. The enlarged spleen also starts pressing the stomach, which leads to the feeling of fullness after eating a small amount of food or even without eating anything. Furthermore, as too many blood cells and platelets have been removed from the bloodstream, the body’s immune response begins to dwindle, symptoms of anemia emerge, and normal blood clotting process is also slows down.

Viral Hepat. 2010 Jul;17(7):488-92. Epub 2009 Oct 13.

Splenectomy and antiviral treatment for thrombocytopenic patients with chronic hepatitis C virus infection.

Ikezawa K, Naito M, Yumiba T, Iwahashi K, Onishi Y, Kita H, Nishio A, Kanno T, Matsuura T, Ono A, Chiba M, Mizuno T, Aketa H, Maeda K, Michida T, Katayama K.
Department of Internal Medicine, Osaka Koseinenkin Hospital, Osaka, Japan.
Thrombocytopenic patients with chronic hepatitis C virus (HCV) infection are poor candidates for antiviral treatment with interferon (IFN), but no standard treatment for thrombocytopenia has yet been established. We evaluated the safety of splenectomy and its efficacy for the initiation and continuation of antiviral therapy.

From March 2003 to April 2006, 10 patients (mean age 62.5 years) with HCV-related cirrhosis, low platelet count (<==106 000/mm(3)) and splenomegaly (spleen size >==10 cm) underwent splenectomy.
Platelet counts significantly increased at 4-8 weeks after splenectomy [pre: 64 200 +/- 6900/mm(3)vs post 209 000 +/- 40 600/mm(3) (P = 0.004)].

No severe operative complications were observed.
All patients subsequently received antiviral therapy. Of the eight patients who were infected with HCV genotype 1 and had a high viral load (>==100 KIU/mL), four received combination therapy with pegylated IFNalpha-2b plus ribavirin, and the other four received standard IFNalpha-2b plus ribavirin.

One patient infected with HCV genotype 2 and another with HCV genotype 1 and a low viral load (less then 100 KIU/mL) were treated with pegylated IFNalpha-2a. Six patients achieved sustained virologic response (SVR).
Six patients achieved sustained virologic response (SVR). Among four patients who failed to achieve SVR, one was given retreatment with pegylated IFN plus ribavirin, and the other three received low-dose long-term IFN therapy.
Although this study was small, the treatment results were similar to those for patients without thrombocytopenia and suggested that splenectomy would not reduce the antiviral efficacy of IFNalpha-based treatment.

PMID: 19840366 [PubMed - indexed for MEDLINE]

Spleen Enlargement on Follow-Up Evaluation: A Noninvasive Predictor of Complications of Portal Hypertension in Cirrhosis
Annalisa Berzigotti
Address requests for reprints to: Annalisa Berzigotti, MD, Dipartimento di Medicina Interna, Cardioangiologia, Epatologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy. fax: (39) 051-6362210,
Paola Zappoli, Donatella Magalotti, Carolina Tiani, Valentina Rossi, Marco Zoli

Background & Aims
Splenomegaly is observed in most but not all patients with cirrhosis, and has been detected more often in patients showing complications of portal hypertension. We aimed to test the hypotheses that spleen enlarges over time in cirrhosis, and that a progressive enlargement may be associated with portal hypertension–related events.
A total of 127 cirrhotic patients (Child–Pugh, 6.7 ± 1.7; range, 5–11), observed at our center and followed-up clinically, endoscopically, and with periodic abdominal ultrasound for at least 1 year, were included. Spleen diameter was recorded at each ultrasound examination. The change of spleen diameter over time was calculated. The occurrence of clinical complications of cirrhosis on follow-up evaluation was recorded.
At inclusion, spleen diameter was 14.9 ± 3.1 cm; 83% of the patients had splenomegaly. Spleen was larger in patients with decompensated disease (n = 39) versus patients with compensated disease (n = 88) (16.1 ± 3.5 vs 14.5 ± 2.7; P = .012).
The mean follow-up period was 53 ± 37 months.
Spleen progressively enlarged over time (analysis of variance, P < .0001). A total of 46.4% of patients showed a spleen enlargement of 1 cm or more at 1 year. Over 5 years of follow-up evaluation patients showing spleen enlargement showed a higher actuarial probability of esophageal varices formation (84.6% vs 16.6%; P = .001) and growth (63.3% vs 20.6%; P = .001).
Among patients with compensated cirrhosis at inclusion, those showing a spleen enlargement had a higher actuarial probability of developing the first clinical decompensation of cirrhosis (51.1% vs 19.5%, P = .002).
Spleen enlargement at follow-up evaluation outlines a subgroup of cirrhotic patients at higher risk of complications of portal hypertension. Noninvasive monitoring of spleen diameter allows a prognostic stratification of cirrhotic patients.
Abbreviations used in this paper: ANOVA, analysis of variance, CI, confidence interval, HVPG, hepatic venous pressure gradient, MELD, Model for End-Stage Liver Disease, OR, odds ratio, US, ultrasound.