From the Guidelines
Splenic infarction is most commonly caused by thromboembolic events, hematologic disorders, vasculitis, trauma, hypercoagulable states, infections, and iatrogenic causes. The causes of splenic infarct can be categorized into several groups, including:
- Thromboembolic events, where blood clots travel to the spleen, often originating from cardiac conditions like atrial fibrillation, endocarditis, or valvular heart disease 1
- Hematologic disorders, particularly sickle cell disease, where abnormal red blood cells can block small vessels, and myeloproliferative disorders like polycythemia vera or essential thrombocythemia
- Vasculitis, which can affect splenic arteries
- Trauma, which may damage splenic vessels directly
- Hypercoagulable states, such as antiphospholipid syndrome
- Certain infections, like endocarditis
- Iatrogenic causes, following procedures like splenic artery embolization Splenic infarcts typically present with left upper quadrant abdominal pain, sometimes radiating to the left shoulder (Kehr's sign), and may be accompanied by fever, nausea, and vomiting. Management focuses on treating the underlying cause while providing supportive care, as most splenic infarcts heal without specific intervention unless complications like abscess formation or rupture occur. It is essential to prioritize the patient's overall clinical condition and to consider the risk of complications when determining the best course of treatment 1.
From the Research
Causes of Splenic Infarct
- Emboligenic heart disease is one of the most frequent causes of splenic infarction, as reported in a literature review 2
- Hematological malignancies, solid neoplasia, and certain infections are also common causes of splenic infarction 2
- Sickle cell disease (SCD) is characterized by a hypercoagulable state that contributes to vaso-occlusive events in microcirculation, which can lead to splenic infarction 3, 4
- SCD is an inherited disorder of hemoglobin, and its complications include stroke, chronic pain, nephropathy, retinopathy, avascular necrosis, priapism, and leg ulcers, which can increase the risk of splenic infarction 5, 6
- Venous thromboembolism (VTE) is a complication of SCD, and its incident event and recurrence rates are consistent with a strong thrombophilia, which can contribute to the development of splenic infarction 4
Risk Factors
- Patients with SCD are at increased risk of developing splenic infarction due to the hypercoagulable state and vaso-occlusive events associated with the disease 3, 4
- The presence of emboligenic heart disease, hematological malignancies, solid neoplasia, and certain infections can increase the risk of splenic infarction 2
- The use of anticoagulants or platelet inhibitors may decrease biomarkers of hemostatic activation, but this has not resulted in improvement in clinically relevant outcomes in patients with SCD 4