Loading...

Splenomegaly

Splenomegaly

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).