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Lupus and the Spleen

The spleen plays a vital role in the body’s immune system and overall health, and though serious lupus complicationss are rare, it is important to understand the role of this master blood filter of the body and how it can be affected by SLE!  

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Introduction: What does the spleen do?

The spleen is a small organ, about the size of a fist lying just under the 9th, 10th and 11th ribs on the left side of the body. Though small, it is the largest organ of the lymphatic system, and it is in that role that it fits into the immune system.

Actually, the spleen, in some ways, can be thought of as two different organs.

First, the spleen acts as a blood filter, like the oil filter in a car.  It physically filters out old, damaged or defective platelets and red blood cells – the red pulp.  In fact, the spleen recycles 90% of the body’s red blood cells – allowing room for new red blood cells to be produced by the bone marrow.

Second, the spleen holds millions of white blood cells (lymphocytes) that do the work of the immune system, including B cells, T cells and mononuclear phagocytes – the white pulp.  In very general terms: B cells produce antibodies; the T cells regulate the B cells and the mononuclear phagocytes physically devour viruses, bacteria and other microorganisms that are brought to the spleen.

In simple terms, think of the spleen as a “security guard” for the bloodstream—it eliminates unwanted cells and foreign invaders, helping the body respond quickly to infections.

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How Lupus Affects the Spleen

With lupus, the immune system goes into overdrive, producing antibodies and other chemicals (like cytokines) that cause inflammation and damage healthy organs.  This can affect the spleen in two ways – either by directly damaging the spleen’s tissues or by forcing it to work harder than usual. This can cause several possible issues, including:

  • Splenomegaly: This is an enlargement of the spleen that results from a process called lymphoid hyperplasia. This condition can affect up to 10% with lupus. Because the spleen has few nerves, it does not always cause noticeable symptoms. However, it can lead to discomfort or pain in the upper left abdomen as well as fatigue.

Splenomegaly can also cause anemia. How?  An enlarged spleen filters blood cells at a faster rate, which can contribute to low red blood cell counts.  This is especially concerning for lupus patients who may already be managing issues like anemia or low platelet counts form their SLE.

  • Splenic Calcification: Some patients with lupus may develop by calcium deposits in the spleen. This condition can progress over time and may be detected through imaging tests like ultrasounds.
  • Spontaneous Splenic Rupture (SSR): Although rare, SSR can occur if fibrin, part of the spleens connective tissue, loses its ability to keep it strong and stable. This condition requires immediate medical attention and often necessitates a splenectomy (removal of the spleen).
  • Splenic Infarcts: These are small areas of dead tissue in the spleen that occur when blood flow to part of the spleen is blocked, often by blood clots. Since blood clots are already a risk factor for people with lupus, splenic infarcts can add another layer of concern. However, they are typically rare and can be managed with close medical monitoring.

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What Symptoms to Look For

Symptoms of spleen involvement in lupus patients can be difficult to identify.  The spleen, like the liver and kidneys, does not have pain sensing nerves, so damage is not directly felt.  However, like those other organs, pain and other symptoms can be sensed by surrounding organs and tissues.

Symptoms may include:

  • Upper left abdominal pain: This pain may sometimes feel sharp and worsen with deep breaths or physical activity.
  • Fatigue and weakness: An overworked spleen may lead to more fatigue and lower energy levels.
  • Low blood counts: If you notice unexplained bruising, pale skin, or dizziness, these could be signs of anemia or low platelet counts, which may indicate spleen involvement. 

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Note: When to Call Your Doctor

If you notice any sudden, severe abdominal pain, fever, unusual fatigue, or signs of infection, don’t hesitate to reach out to your healthcare provider. Lupus and its effects on the spleen may require specialized care, so it’s always best to err on the side of caution.

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Treatments and Caring for Your Spleen with Lupus

The best way to treat a problem spleen is to stick with a lupus treatment plan that takes into account any anemia or organ damage that has occurred.  If the spleen is severely damaged, it may need to be surgically removed.

Splenectomy: The body can cope without the spleen, although the person might be more susceptible to infections after the operation. In some cases, it is possible to remove only the diseased or damaged parts of the spleen. This allows the remaining healthy portions to keep functioning as normal.

After a splenectomy, the person’s blood may contain more odd-shaped red blood cells than normal.  The patient also are at increased risk of infection, most commonly pneumococcal and meningococcal infections. While these are rare, they can develop into severe infections (sepsis) without prompt intervention. Vaccines are recommended especially for these people and they should be discussed with a doctor.

There’s no specific diet or lifestyle that can prevent spleen issues in lupus patients, but focusing on general lupus management can help reduce the risk. This includes:

  • Regular check-ups: Regular blood tests can keep track of your blood cell counts, helping to catch any potential spleen issues early.
  • Managing flares: By keeping lupus flares under control, you reduce the stress on your immune system and, by extension, your spleen.
  • Staying vigilant with infections: Since the spleen helps fight infections, it’s even more important to avoid infections as much as possible. Stay current with vaccinations, practice good hygiene, and talk to your doctor if you notice signs of infection.
  • Healthy lifestyle habits: A balanced diet, low in processed foods and high in nutrients, along with regular light exercise, can help support immune health and reduce inflammation.

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In Conclusion

Understanding the connection between lupus and the spleen can empower you to recognize potential symptoms and know when to seek help. While spleen issues are not common in every lupus patient, being informed and proactive can help you stay one step ahead. And if a person with lupus does experience these symptoms, it is important to discuss them with a healthcare provider.

Remember, you’re not alone in this journey—working closely with your healthcare team is your best resource for managing lupus and all the ways it may impact your body.

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References

Cleveland Clinic. (2024, October 29). Spleen. Cleveland Clinic. https://my.clevelandclinic.org/health/body/21567-spleen

Cruz, A. J., & Castro, A. (2015). Systemic lupus erythaematosus presenting as spontaneous splenic rupture. BMJ case reports.  https://doi.org/10.1136/bcr-2015-212531

Louza, G. F., Barreto, M. M., Zanetti, G., & Marchiori, E. (2018). Systemic lupus erythematosus with diffuse splenic calcifications: a rare combination. Radiologia Brasileira, 51(6), 407–408. https://doi.org/10.1590/0100-3984.2017.0109

Su S, & Zhong H. (2023). Systemic lupus erythematosus with diffuse splenic calcification: a case report. Immunity, Inflammation and Disease, 11(7) e927. https://my.clevelandclinic.org/health/body/21567-spleen

Tieng, A.T., Sadow, C.A., Hochsztein, J.G., & Putterman, C. (2011). Diffuse calcifications of the spleen: A novel association with systemic lupus Erythematosus, Seminars in Arthritis and Rheumatism, 41(2), 187-193, https://doi.org/10.1016/j.semarthrit.2010.10.003.

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Author: Greg Dardis, MS      

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University and the American College of Healthcare Sciences.  His focus has been human biology and physiology with an interest in  autoimmunity.  Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.

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All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

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