Table Indications for Splenectomy or Radiation Therapy in Hypersplenism Indication Examples Excessive bleeding Hypersplenic thrombocytopenia Hemolytic syndromes in which splenomegaly further shortens the survival of intrinsically abnormal red blood cells Hereditary spherocytosis Thalassemia Mechanical encroachment on other abdominal organs Calyceal obstruction in left kidney Stomach with early satiety Severe pancytopenia associated with massive splenomegaly Hairy cell leukemia Lipid-storage diseases * Myeloproliferative neoplasms Vascular insults involving the spleen Bleeding esophageal varices associated with excessive splenic venous return due to portal hypertension Recurrent infarctions * The spleen may be up to 30 times larger than normal.