Reviewed by: HU Medical Review Board | Last reviewed: June 2023 | Last updated: July 2023
An enlarged spleen (splenomegaly) is a common symptom of lupus, occurring in 10 percent to 46 percent of those with active disease. It is generally caused by blood abnormalities caused by the inflammation of lupus.1
For most people with lupus who have an enlarged spleen, it is a mild-to-moderate complication that can contribute to low platelet counts (thrombocytopenia) of 60,000 to 150,000/microL. The most common reason for people with lupus to have low platelet counts is that healthy platelets are attacked by the immune system and then get trapped in the spleen. It is rare for splenomegaly to become serious, but when platelet counts become very low and do not improve with medications, removing the spleen may help.2
What is a splenectomy?
A splenectomy (spluh nek’ tuh mee) is the medical term for a surgery to remove your spleen. The surgery may be performed laparoscopically (minimally invasive surgery) or open (traditional) surgery.
When is a splenectomy recommended?
At one time, splenectomy was the only option to treat thrombocytopenia caused by lupus. Today, many doctors prefer to treat low platelet count (below 20,000 to 30,000/microL) with steroids and other immunosuppressants.1-2
Your doctor may only suggest a splenectomy when all other options have failed because surgery can be risky for people with lupus.
Is splenectomy safe for people with lupus?
While doctors prefer to use drugs to treat the thrombocytopenia caused by an enlarged spleen, removal of the spleen works well for many people with lupus. Of those people who have their spleen removed, some studies show success rates as high as 60 percent in relieving low platelet counts.1
One small study from Mexico found that 85.7 percent of those who had the surgery achieved complete remission of low platelets and had to take less prednisone (steroids) than the year before surgery.3
Special surgical precautions for people with lupus
While the risks of surgery are getting better, patients with lupus tend to be sicker and more vulnerable to complications after surgery than people without lupus. That is why people with lupus must be monitored closely before, during, and after any surgery.4
Major surgery such as a splenectomy will need to be planned ahead of time and coordinated with the person’s rheumatologist and hematologist. This allows time to stop or start taking medications that may increase the risks of surgery and recovery.
That said, a large study in Taiwan found that people with lupus experienced much higher rates of serious complications in the 30 days after major surgery. The most common problems were kidney failure, pneumonia, blood clots in the lungs or brain, and septicemia (blood poisoning).5
During surgery, anyone with lupus must be watched closely to avoid organ damage and blood clots. After surgery, 10 percent to 35 percent of people with lupus have an increased risk of blood clots in the legs which is also known as deep vein thrombosis.4 To prevent infections post-surgery, vaccines for flu, pneumonia, and meningitis may be recommended.1