What does an enlarged spleen mean to someone with hepatitis?

January 14, 2013 8:01 AM

So my friend's girlfriend has had autoimmune hepatitis and primary schlerosing cholingitis, but with normal bloodwork. They recently found her spleen had enlarged. I know this is caused by either portal hypertension or high iron levels... but is there anything else to consider in terms of either cause or prognoisis. What should she do from here on out or watch for?
posted by marsbar77 to health & fitness (4 answers total)

Are you sure you mean high iron levels and not iron deficiency anemia? If your friend's girlfriend has elevated iron levels, then the question would be why (multiple blood transfusions? some other reason?)

This is a really high level question (i.e. not really appropriate to "ask the hive mind") - is there a reason why she hasn't asked her hepatologist?

I really can't speak to what's going on in your friend's girlfriend's case AT ALL, but I can tell you this about the conditions you mentioned.
Splenomegaly due to portal hypertension is a symptom of advanced primary sclerosing cholangitis (it happens in the course of liver failure/cirrhosis, in other words). People who have liver failure/cirrhosis generally do not have normal blood work, but who knows what "normal blood work" means because there are thousands of blood tests a person can get done.
As you or your friend probably know, the mainstay of long term treatment for the disease is liver transplantation.

Iron deficiency can be treated with iron, and iron overload can be treated with bloodletting, so that's a heck of a lot simpler than getting a transplant.
posted by treehorn+bunny at 8:54 AM on January 14

My fit, young and athletic brother has autoimmune hepatitis and a very enlarged spleen. He is at a high risk for a spleen rupture if he get hit in torso and from time to time he turns yellow.

What I can suggest to your friend is that she find the very best hepatitis (liver doc) she can. This is a tricky condition that requires careful monitoring, frequent blood work and a precise use of medication. It is far beyond anything that you can find by looking online here or anywhere else. This is exactly what specialists are for.
posted by saradarlin at 9:16 AM on January 14

Yeah. Get her to a doc.(If she hasn't already.) Her doc will be able to answer any questions about the spleen. PSC is not to be ignored. She'll probably need a liver transplant(eventually), as said above. So she needs to remain as healthy as possible before her liver gets worse.
posted by hot_monster at 1:20 PM on January 14

Person with PSC here. I have an enlarged liver and spleen.

Most likely is that the there is some back flow of blood into the spleen causing it I enlarge. Not a huge problem - unless it gets huge, in which case the docs will shift into high gear.

This doesn't mean advanced lover disease or imminent liver failure. One of the sucky things about PSC is there is no prognostic model and many patients have wildly different symptoms at different points of progression.

Two things to watch out for going forward (note: don't expect these, just watch out for them):

* There is obviously pressure where there shouldn't be. This can lead to oesophical varicies. So any vomiting of blood get to A&E right away.

* Lowered immune system. The spleen cleans the old white cells from the blood. If it is enlarged this can happen too much and the immune system can drop. Docs will keep an eye on this with blood tests.

Oh, and the normal blood tests. Very quickly with chronic illnesses docs will switch from the national agreed normal to 'normal for you' normal.

Of course I am not a doctor. But MeFi mail me if you like.
posted by Nufkin at 2:01 PM on January 14