Normal spleen size is proportionate to gender and body habitus


Non-Haematological Causes:


  • 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



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


Haematological Causes:


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



  • 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



  • 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



NICE CKS: Haematological cancers, November 2016

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



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