Splenomegaly

 

Normal spleen size is proportionate to gender and body habitus

 

Non-Haematological Causes:

Common

• Liver disease
  • Cirrhosis
  • Hepatic vein & Portal vein thrombosis

• Acute and chronic infections
  • Glandular fever, viral hepatitis
  • TB, Brucellosis
  • Infective endocarditis
  • Tropical disease (Malaria, Schistosomiasis, Leishmaniasis)

• Congestive cardiac failure

 

Rare

• Connective tissue abnormalities – Systemic Lupus, Felty’s Syndrome
• Sarcoid, amyloid
• Storage disorders eg. Gaucher disease

 

Haematological Causes:

Common

• Lymphoproliferative disorders (LPD) eg. CLL
• Myeloproliferative disorders (MPD)
  • CML, Myelofibrosis, Polycythaemia Vera, Essential Thrombocytosis

• Lymphoma

 

Rare

• Haemoglobinopathies  & Congenital red cell abnormalities
• Haemophagocytic Lymphohistiocytosis, Langerhan’s cell Histiocytosis

 

Important features Hx/ Examination:

Red Flag Symptoms: Fevers, night sweats, weightloss, pruritus, alcohol induced lymph node pain

Signs: Anaemia, Lymphadenopathy, petechiae, unexplained bruising, other signs liver disease

 

Investigations:

• Blood count with film
  • (LPD and MPD will invariably have an abnormal blood count)
  • NBAny cause of splenomegaly may cause cytopenias (‘hypersplenism’)
• LFTs/LDH
• Consider reticulocyte count, if raised do Direct Antiglobulin test
• Consider Viral serology-EBV/HIV/Hepatitis viruses

 

Who to refer?

If suspected Lymphoma- REFER 2WW HAEMATOLOGY

If other haematological cause suspected & non haematological causes have been excluded- Refer Haematology via C&B

 

References:

NICE CKS: Haematological cancers, November 2016

BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/895

 

Contributors:

Dr Richard Noble, Consultant Haematologist, RCHT

Dr Bridgitte Wesson, GP & Kernow RMS Haematology guideline lead

 

Review date: 13/09/2020

Next Review date: 13/09/2021