Understanding Splenomegaly

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Dr. Ruben Mesa, deputy director at Mayo Clinic Cancer Center, describes splenomegaly, an enlarged spleen. He explains how the spleen functions and why individuals with MPN develop splenomegaly, which can be painful.

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Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:        

Dr. Mesa, so let’s move on to splenomegaly, which I now know is the enlarged spleen, and I’ve developed that and that was kind of worrisome. But, just as a show of hands, how many people got this sort of shocker that you were feeling something under your rib cage? So people know that. So where does that come from, an enlarged spleen? What’s that about?

Dr. Mesa:     

So, it’s a good question, and what you see on the slide is that there are some things on the myelofibrosis side of the line and some things on the ET and PV side of the line. And the reality is that there is a blend, you know, in that all of these features can be present on one side of the line or the other, but are a bigger feature on one side or the other. So a big spleen, well, first, what does a spleen do? The spleen really does two things. The spleen’s involved with our immune system, and the spleen is a filter for the blood.

Now, ordinarily, our spleen, we shouldn’t feel it at all. It’s about the size of a fist normally, and it should be well up under the rib cage. So by the time we can feel the spleen, it’s probably three times as big as it should be. That’s the time we can feel the tip of the spleen. Now, it clearly can get to be much larger than that in patients with MPNs. Now, why does it get big? As we’ve looked at it, nobody knows all aspects of the spleen in the disease in that it’s a complex relationship.

But really part of the reason is that there are cells being filtered that leak from the bone marrow, that proceed to be in the spleen from that filter side and can grow in the spleen. So that tends to be a bigger feature in MF, and, in some people, the spleen can become a big issue in terms of discomfort. It can cause pain. It can cause people to be somewhat resistant to getting blood transfused, because it holds onto too much of the cells that are transfused.

If people are losing weight, it does no one any favors, because it’s pressing on the stomach. Now, it can be where we can feel it in ET and PV. So it can be enlarged along the way but clearly is a much bigger issue typically in MF.

Andrew Schorr:      

Is this a correct image of a vacuum cleaner that’s getting clogged?

Dr. Mesa:     

To some degree. You could think that the stuff that gets clogged then starts to grow a little bit on its own as well. So, the stuff in the bag, you know, starts to even percolate a little bit itself. But that’s not a bad analogy.

Please remember the opinions expressed on Patient Power are not necessarily the views of MD Anderson Cancer Center, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on April 23, 2014