[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [White cells, lymph nodes, spleen and thymus](https://durgical.com/en/general-pathology/areas/hematolymphoid/) › Splenomegaly and hypersplenism

# Splenomegaly and hypersplenism

- Lesion

A spleen grows when it works harder, holds back blood, is invaded by cells or stores material. A big spleen can trap blood cells.

Updated Nov 12, 2026

## Key points

- Massive splenomegaly: CML, primary myelofibrosis, hairy cell leukaemia, chronic malaria, visceral leishmaniasis, Gaucher disease, thalassaemia major.
- Congestive splenomegaly: cirrhosis is the main cause; the spleen can become very large and firm.
- Gamna–Gandy bodies: fibrotic, iron- and calcium-encrusted foci of old haemorrhage in a congested spleen.
- Acute splenitis: soft, red, enlarged spleen in blood-borne infections such as endocarditis; follicles may necrose.
- Hypersplenism: cytopenias corrected by splenectomy.

## What it is

The spleen filters blood, removes old and damaged cells, mounts immune responses and can make blood cells when the marrow fails. It enlarges through five mechanisms: infection and immune activation, congestion from portal hypertension or heart failure, haematologic neoplasms and extramedullary haematopoiesis, increased removal of abnormal red cells, and storage or infiltrative diseases. A large spleen of any cause can sequester and destroy blood cells, lowering counts (hypersplenism).

## Structure

- Acute splenitis: soft, diffluent red pulp full of neutrophils and plasma cells; sometimes abscesses.
- Chronic congestion: firm, enlarged spleen with dilated sinusoids, thick fibrotic cords and Gamna–Gandy bodies.
- Infiltrative: white pulp expansion in lymphomas, red pulp in hairy cell leukaemia and myeloid neoplasms, pale foamy cells in storage disorders.

## Step by step

- Increased work: immune stimulation enlarges the white pulp; removal of abnormal red cells enlarges the red pulp.
- Raised venous pressure (portal hypertension, right heart failure, splenic vein thrombosis) dilates sinusoids.
- Neoplastic or extramedullary haematopoietic cells, or storage macrophages, fill the organ.
- Slow transit through the cords exposes blood cells longer to macrophages.
- Cells are pooled and destroyed: anaemia, neutropenia and thrombocytopenia (hypersplenism).

## Splenomegaly by mechanism

| Mechanism | Examples | Size |
| --- | --- | --- |
| Infection and immune activation | Endocarditis, mononucleosis, tuberculosis, typhoid, brucellosis, malaria, leishmaniasis, lupus | Mild to massive (malaria, leishmaniasis) |
| Congestion | Cirrhosis, portal or splenic vein thrombosis, right heart failure, schistosomiasis | Moderate to massive |
| Haematologic neoplasm and extramedullary haematopoiesis | CML, myelofibrosis, hairy cell leukaemia, lymphomas | Often massive |
| Red cell destruction | Hereditary spherocytosis, thalassaemia, autoimmune haemolysis | Moderate |
| Storage and infiltration | Gaucher and Niemann–Pick disease, amyloidosis, Langerhans cell histiocytosis | Moderate to massive |
| Mass lesions | Cysts, haemangioma, metastases | Variable |

## Clinical notes

- A dragging feeling in the left upper quadrant, early satiety, and cytopenias.
- In Colombia, chronic malaria and visceral leishmaniasis (Caribbean region) are important causes of a very large spleen in endemic zones.
- A rapidly enlarging soft spleen is at risk of rupture.

## Memory aid

Five reasons a spleen grows: it fights, it backs up, it is invaded, it eats too many red cells, or it stores.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the main cause of congestive splenomegaly?

Cirrhosis with portal hypertension.

## What are Gamna–Gandy bodies?

Fibrotic nodules encrusted with iron and calcium from old haemorrhages in a chronically congested spleen.

## What are three causes of massive splenomegaly?

Chronic myeloid leukaemia, primary myelofibrosis and chronic malaria (also hairy cell leukaemia, visceral leishmaniasis, Gaucher disease).

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## Elsewhere in DurgiPedia

- [Lymph node and spleen under the microscope](https://durgical.com/en/histology/lymph-node-and-spleen-under-the-microscope/)
- [Spleen: white pulp, red pulp, asplenia](https://durgical.com/en/immunology/spleen-white-pulp-red-pulp-asplenia/)
- [The red cell life cycle and the spleen](https://durgical.com/en/physiology/the-red-cell-life-cycle-and-the-spleen/)

## Connections

## Related 4

- [Hyperemia and congestion (the nutmeg liver, heart-failure cells)](https://durgical.com/en/general-pathology/hyperemia-and-congestion/)
- [Portal hypertension](https://durgical.com/en/general-pathology/portal-hypertension/)
- [Other lesions of the spleen](https://durgical.com/en/general-pathology/other-lesions-of-the-spleen/)
- [Thrombocytopenia: mechanisms](https://durgical.com/en/general-pathology/thrombocytopenia-mechanisms/)

## Related conditions 11

- [Portal hypertension](https://durgical.com/en/conditions/portal-hypertension/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)
- [Malaria](https://durgical.com/en/conditions/malaria/)
- [Leishmaniasis](https://durgical.com/en/conditions/leishmaniasis/)
- [Infectious mononucleosis](https://durgical.com/en/conditions/infectious-mononucleosis/)
- [Gaucher disease](https://durgical.com/en/conditions/gaucher-disease/)
- [Chronic myeloid leukaemia](https://durgical.com/en/conditions/chronic-myeloid-leukaemia/)
- [Hereditary spherocytosis](https://durgical.com/en/conditions/hereditary-spherocytosis/)
- [Thalassemias (α and β)](https://durgical.com/en/conditions/thalassemias/)
- [Infective endocarditis](https://durgical.com/en/conditions/infective-endocarditis/)
- [Essential thrombocythaemia and primary myelofibrosis](https://durgical.com/en/conditions/essential-thrombocythaemia-and-primary-myelofibrosis/)

## Microorganisms 4

- [Plasmodium falciparum](https://durgical.com/en/microbiology/plasmodium-falciparum/)
- [Plasmodium vivax](https://durgical.com/en/microbiology/plasmodium-vivax/)
- [Leishmania infantum](https://durgical.com/en/microbiology/leishmania-infantum/)
- [Epstein–Barr virus](https://durgical.com/en/microbiology/epstein-barr-virus/)

[← All of general pathology](https://durgical.com/en/general-pathology/)

Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Splenomegaly: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/003276.htm) (MedlinePlus, US National Library of Medicine, 2026); [Malaria in Brazil, Colombia, Peru and Venezuela: current challenges in malaria control and elimination](https://europepmc.org/article/PMC/PMC5496604) (Malaria journal, 2017).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/splenomegaly-and-hypersplenism/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/splenomegaly-and-hypersplenism/