Introduction:

• It is occurrence of one or more cytopenias in the setting of splenomegaly.

Etiology:

• All the causes of splenomegaly can lead to hypersplenism
• Refer to causes of splenomegaly in the approach to diagnosis section

Pathogenesis:

Increased size of filtering bed due to splenomegaly

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Increased proportion of blood is channeled through the red pulp

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Increased margination of neutrophil pool

Increased sequestration of platelets

Increased clearance of RBCs

Cytopenias can also be due to diseases that cause splenomegaly

Clinical Features:

• Sagging feeling/ abdominal discomfort
• Early satiety due to gastric encroachment
• Trouble in sleeping on one side
• Splenomegaly

Investigations:

• Hemogram- Anemia, neutropenia, thrombocytopenia
• USG- Splenomegaly

Criteria for Diagnosis:

• Tropical splenomegaly: Splenomegaly of more than 10cm below costal margin with no other cause identified.
• Sometimes it responds to treatment with antimalarials (Chloroquine), which have to be given for months.

Treatment:

• Depends on the cause
• Splenectomy is useful in some cases, but generally avoided.
• Splenic irradiation
• TPO agonists may be helpful
  • Eltrombopag is associated with high risk of portal vein thrombosis. Hence it must be used with caution.
  • Avatrombopag is approved for use in chronic liver disease