Abdominal swelling may manifest as a symptom of thalassemia due to a couple of mechanisms. The spleen, an organ located in the abdomen, has various functions, including breakdown and removal of hemoglobin components in dead, damaged, and worn out red blood cells. The hemoglobin components are sent to the liver to be re-used. However, this healthy process does not occur in thalassemia patients. Instead, the inadequate production of hemoglobin means most iron in the spleen is not recycled because there is not enough hemoglobin being produced to need it. This mechanism results in a physical buildup of iron and other unused red blood cell components in the spleen. In addition, several organs such as the liver, lymph nodes, and spleen are responsible for producing different types of blood cells in addition to those produced by bone marrow. Because the bone marrow is not able to produce enough functioning red blood cells to keep up with their high turnover rate, these other organs attempt to compensate with an increase in their production of blood cells. This mechanism results in the liver, gallbladder, and spleen becoming enlarged and presents as swelling in the abdomen.
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