If fever persists, returns, or occurs with significant weakness, abdominal pain, or other concerning symptoms, medical evaluation is important.
6. What Causes Spleen Problems?
There is no single cause of splenomegaly. The underlying reason depends on a person's medical history, examination, blood tests, and imaging results.
Several broad categories are particularly important.
Viral Infections
Some viral infections can temporarily enlarge the spleen.
One well-known example is infectious mononucleosis, often associated with the Epstein-Barr virus.
Symptoms may include:
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Fever.
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Sore throat.
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Swollen lymph nodes.
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Fatigue.
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Enlarged tonsils.
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Enlargement of the spleen.
Not everyone with mononucleosis develops noticeable splenomegaly.
Because an enlarged spleen is more vulnerable to injury, people diagnosed with this condition may be advised to avoid contact sports, heavy lifting, and activities that could cause abdominal trauma until their clinician confirms that it is safe to return.
Other viral illnesses may also affect the spleen.
Bacterial and Parasitic Infections
Certain bacterial infections can cause inflammation or enlargement of the spleen.
Depending on geographic location and exposure history, parasitic infections may also be relevant.
Malaria, for example, can affect red blood cells and the spleen.
The appropriate investigation depends on travel history, local infection patterns, symptoms, and laboratory findings.
Liver Disease
The spleen and liver are closely connected through the portal venous system.
When blood flow through the liver becomes restricted, pressure may increase in the portal vein. This is known as portal hypertension.
Cirrhosis is an important cause of portal hypertension.
Increased pressure can cause the spleen to enlarge and retain more blood cells.
This may contribute to low platelet counts and, in some cases, low white blood cell or red blood cell counts.
People with chronic liver disease may require monitoring of both liver function and spleen-related complications.
Blood Disorders
Some blood disorders affect how blood cells are produced, shaped, or destroyed.
Examples include:
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Sickle cell disease.
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Thalassemia.
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Hereditary spherocytosis.
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Certain hemolytic anemias.
In these conditions, the spleen may work harder to remove abnormal red blood cells.
Depending on the disease, the spleen may become enlarged or its function may change.
Blood Cancers and Lymphatic Disorders
Certain cancers involving blood-forming cells or the lymphatic system can affect the spleen.
Examples include some forms of leukemia and lymphoma.
These conditions may produce symptoms such as:
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Persistent fatigue.
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Unexplained fever.
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Night sweats.
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Unintentional weight loss.
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Enlarged lymph nodes.
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Easy bruising.
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Changes in blood counts.
These symptoms can also occur in many noncancerous conditions.
An enlarged spleen alone does not mean a person has cancer. Diagnosis requires appropriate testing.
Autoimmune and Inflammatory Conditions
Some immune system disorders can affect the spleen.
For example, rheumatoid arthritis and systemic lupus erythematosus may be associated with changes in spleen function or blood cell counts.
In certain people with rheumatoid arthritis, an uncommon condition called Felty syndrome involves rheumatoid arthritis, an enlarged spleen, and a low neutrophil count.
The presence of joint pain or an autoimmune diagnosis does not automatically mean the spleen is affected.
Physical Injury
A blow to the abdomen can injure the spleen.
Possible causes include:
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Road traffic accidents.
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Falls.
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Sports injuries.
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Direct impacts during physical activity.
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Penetrating abdominal injuries.
Because the spleen contains many blood vessels, a serious injury can cause internal bleeding.
Importantly, symptoms may not always appear immediately after an injury.
Anyone with significant abdominal trauma, especially when accompanied by pain, dizziness, weakness, or fainting, needs urgent medical assessment.
7. How Doctors Determine Whether the Spleen Is Enlarged
A diagnosis should not be based on symptoms alone.
Doctors usually combine medical history, physical examination, blood tests, and imaging.
Medical History
A clinician may ask about:
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The location and duration of abdominal discomfort.
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Recent infections.
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Unexplained weight changes.
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Fever or night sweats.
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Bleeding or bruising.
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Liver disease.
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Blood disorders.
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Travel to areas where malaria is present.
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Recent abdominal injuries.
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Current medications and supplements.
These details help narrow down possible causes.
Physical Examination
The doctor may gently examine the abdomen to assess whether the spleen can be felt beneath the ribs.
They may also look for signs of liver disease, swollen lymph nodes, pallor, bruising, or other abnormalities.
A physical examination can provide useful clues, but it cannot always confirm or exclude splenomegaly.
Complete Blood Count
A complete blood count, commonly called a CBC, measures several components of the blood.
It usually includes:
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Red blood cell count.
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Hemoglobin.
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White blood cell count.
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Platelet count.
Abnormal results may suggest anemia, low platelets, low white blood cells, or other conditions.
A clinician may also request a blood smear to examine the appearance of blood cells under a microscope.
Liver Function Tests
Because liver disease and portal hypertension can contribute to spleen enlargement, doctors may order blood tests that assess liver health.
These may include measurements of liver enzymes, bilirubin, albumin, and other indicators.
No single blood test can establish every cause of splenomegaly.
Ultrasound
Abdominal ultrasound is commonly used to assess spleen size.
It can also provide information about the liver, surrounding structures, and blood flow.
The test is noninvasive and does not use ionizing radiation.
CT or MRI Scans
A CT scan may be used when doctors need more detailed information about the spleen or surrounding abdominal organs.
It can be particularly useful in evaluating abdominal trauma, suspected internal bleeding, masses, or complications.
MRI may be appropriate in selected situations.
The choice depends on the clinical question and the patient's circumstances.
8. Can an Enlarged Spleen Return to Normal?
Sometimes, yes.
The outcome depends on the underlying cause.
If the spleen becomes enlarged because of a temporary infection, it may gradually return toward its usual size as the infection resolves.
If the enlargement is associated with chronic liver disease, a blood disorder, or another long-term condition, it may persist.
Treatment is therefore directed at the underlying problem rather than simply trying to reduce the size of the spleen.
For example: