Definition
Splenomegaly denotes a palpable spleen, or an enlarged spleen detected by USS or CT / MRI scan.
Presentation ranges from a massively enlarged spleen to mild splenomegaly only detected on imaging. Increasingly, splenomegaly is noted as an incidental finding in imaging studies performed for other reasons.
Isolated splenomegaly is a feature of a number of diverse problems including:
- infections such as malaria and infective endocarditis;
- chronic liver disease; autoimmune disorders including rheumatoid arthritis, Felty’s syndrome and SLE;
- Gaucher’s disease and sarcoidosis.
Haematological causes include autoimmune haemolysis, hereditary spherocytosis, myeloproliferative disorders, myelofibrosis, leukaemias and lymphomas.
C.M & L.W 31-07-23
Who to refer:
Those with
- Splenomegaly >15cms– majority likely to have a haematological disorder
- Significant additional systemic symptoms: weight loss, fever, alcohol induced pain
- Associated nodal enlargement
- Increased reticulocyte count and/or DCT positive
- Abnormal FBC either cytopenias or cytoses, lymphocytosis or leucoerythroblastic blood film
Who not to refer:
Those with chronic liver disease and portal hypertension
How to refer:
SCI Gateway to Department of Haematology WGH or SJH.
Primary care investigations
- FBC
- Blood film
- CRP
- Reticulocyte count, if raised check Direct Antiglobulin Test (DAT) test
- LFTs and LDH
- Viral serology for EBV (IgM),HIV & Hepatitis viruses
- Quantitative immunoglobulins
If additional clinical features to suggest a diagnosis of SLE, RA or other connective tissue disorder check CCP, ANA, dsDNA (if ANA positive).
