Common Causes Of An Enlarged Spleen In A Child In The Tropics

in air-clinic •  3 months ago


We talked about enlarged spleen which can be associated with liver enlargement last week. A quick look at it and from some of the comments l got, one might think that every abdominal swelling is caused by an enlarged spleen or liver. No! It's not. Several other things can make the belly to swell up ranging from accumulation of excess fluid to feaces, fat, gas, or swelling from any other organ or structure inside the abdomen other than the spleen.

In abdominal swelling caused by enlarged spleen or liver, you feel a hard mass on either or both sides of the abdomen when you touch it

Causes of enlarged spleen

A lot of illnesses can make the spleen to enlarge which includes malignancies such as leukemia and lymphoma, lipid storage disorders, glycogen storage disorders, congestive heart failure, chronic granulomatous diseases, spherecytosis, thalasaemias, sarcoidosis, infections and inflammatory conditions affecting the liver, obstruction of blood flow to the liver, liver failure and even trauma that cause accumulation of blood (hematoma) in the spleen. All these are possible but rare causes of enlarged spleen in a child in the tropics, which is the emphasis of this article.

Now in the tropics like Africa

Palpating the spleen in newborn babies is a normal finding which disappears with age. In children less than 5yrs, the tip of the spleen could still be felt below the left costal margins. The spleen enlarges at least three times it's normal size before being readily palpable in the abdomen.

Most patients presenting with enlarged spleen usually have associated liver enlargement, anaemia, fever, yellowness of the eyes or enlarged lymph nodes and are chronically ill -looking. Marrying the splenomegaly with other associated symptoms will give a clue to what the problem is.

The common causes of an enlarged spleen here include:

  • Malaria
  • Tropical splenomegaly syndrome
  • Sickle-cell-anemia
  • Malnutrition,
  • Severe anaemia
  • Immunosuppression
  • Worm infection (schistosomiasis)
  • Typhoid infection

The reason the spleen enlarges

The spleen performs several vital functions in the human body and such include :

  • It fights infection by removing microorganisms and other harmful substances from the blood.
  • It synthesizes immunoglobulin G and other components of the immune system that helps keep you healthy
  • It removes abnormal, old or worn out red blood cells (RBCs) by destroying them as they pass through it.
  • It responsible for blood production in early life and in some disease conditions that reduce blood levels (extramedullary hematopoiesis).

The spleen enlarges while performing its normal function. Any condition that will make any of these normal functions to increase can cause the spleen to enlarge

OK, let's relate it to some of the above causes

  • Someone suffering from malnutrition might have low immunity and increase risk of infection and this will increase the immunological function of the spleen.
  • Sickle cell anemia among other ways will cause increased amount of abnormal RBCs and the spleen hyper function to eliminate them.
  • Malaria, sickle-cell-anemia and other heamolytic conditions will cause increased destruction of blood cells leading to severe anaemia. This can make the spleen to begin production of blood cells and in the process gets enlarged.

How is enlarged spleen treated?

A lot of questions came from here. People are eager to hear the treatment other than the scarification marks and herbal concussions. I hope you would not be disappointed.

There is no specific treatment for an enlarged spleen. The treatment is directed towards treatment of the cause of the enlarged spleen.
Once the offending factor is addressed, the spleen gradually returns to its normal size.

Please take your child to a health expert for proper evaluation for the cause of the splenomegaly and treatment accordingly . Scarification marks and herbal concussions do more harm to the child .

Thanks much for reading.


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Nicely explained the causes of enlarged spleen. In this regard, it should be mentioned that autosplenectomy may happen in sickell cell disease.

Posted using Partiko Android

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Thanks for reading. Of course autosplenectomy is one of the long term consequences of Sickle-cell-anemia. It's not just a consequence of hyper functioning of the spleen. Repeated spleenic infarcts is also attributed. Most of the time the spleen gets enlarged before getting to that.

Thanks much for your input.

How does malnutrition contribute to splenomegaly? I can't seem to connect the dot.

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Thanks for reading. A malnourished child is likely going to have a low immunity and increased susceptibility to infections. The spleen trying to control this can get enlarged.

Meanwhile some of these are not in isolation. That malnourished child can still be severely anaemic, or have any of the other symptoms.

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So, in a sense, malnutrition indirectly leads to splenomegaly, correct?

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