HNY Policy and Pathway Repository - York

Enlarged spleen.

The size of the spleen is determined by sex, age and height. We recommend using this calculator to determine the expected spleen size: https://qxmd.com/calculate/calculator_384/expected-spleen-size

Causes of splenomegaly include:

• Liver disease with portal hypertension
• Viral infection e.g. EBV, CMV
• Other infections e.g. tuberculosis, infective endocarditis, tropical diseases, syphilis
• Autoimmune diseases e.g. rheumatoid arthritis
• Metabolic storage disorders e.g. Gaucher’s disease
• Sarcoidosis
• Haematological malignancy (Lymphoma, Myeloproliferative neoplasms)
• Haemolytic anaemias, thalassaemia and haemoglobinopathies

Refer urgently to haematology if:

• If spleen is >14cm
• There are additional features raising concern of haematological disease, such as
  • drenching night sweats,
  • unexplained weight loss,
  • lymphadenopathy or
  • relevant blood count abnormalities

History and examination

Compare to previous imaging if available. Ask about symptoms relating to spleen size e.g. pain, early satiety. Clinically evaluate for above causes including asking about B symptoms (drenching night sweats, unexplained weight loss, intractable itching), recent viral infection, features of autoimmune disease, family history and travel history.

 

Investigations

• Full blood count and blood film (request at source, give clinical information)
• Ultrasound scan of abdomen
• Liver function tests including GGT and alcohol history
• Viral screen e.g. EBV, CMV, HIV, hepatitis B and C
• Haemolysis screen (blood film, reticulocyte count, LDH, LFTs, haptoglobin, DAT)
• Immunoglobulins and serum protein electrophoresis
• Autoimmune screen if history suggestive
• Others depending on clinical history and examination

 

Management

• If spleen is >14cm and/or there are additional features raising concern of haematological disease, such as drenching night sweats, unexplained weight loss, lymphadenopathy or relevant blood count abnormalities, then refer to haematology urgently
• For Mild homogenous splenomegaly (14cm or less) without additional features of concern or identified cause, repeat ultrasound scan in four to six months to see if resolving and to ensure not increasing in size.
• If spleen is >14cm AND the patient is well, OR spleen increases on the 6/12ly repeat US scan, then refer haematology routinely

None provided