A clinically palpable spleen has many causes including:
(a) acute-septicaemia, infective endocarditis, typhoid, infectious mononucleosis
(b) chronic- tuberculosis and brucellosis
(c) parasitic-malaria, kala-azar and schistosomiasis
2 Inflammation: rheumatoid arthritis, sarcoidosis, SLE 3 Haematological: haemolytic anaemia, haemoglobinopathies and the Ieukaernias, lymphomas and myeloproliferative disorders
4 Portal hypertension: liver disease
5 Miscellaneous: storage diseases, amyloid, primary and secondary neoplasias, tropical splenomegaly Massive splenomegaly is seen in myelofibrosis, chronic myeloid leukaemia, chronic malaria, kalaazar or, rarely, Gaucher’s disease.
Investigation is that of the primary disorder. The spleen can be visualized by ultrasound or CT scanning. Splenic function can be assessed with isotope scanning.
This can result from splenomegaly due to any cause. It is commonly seen with splenomegaly due to haematological disorders, portal hypertension, rheumatoid arthritis (Felty’s syndrome) and lymphoma. Hypersplenism produces:
• Haemolysis due to sequestration and destruction of red cells in the spleen
• Increased plasma volume
Treatment is often dependent on the underlying cause but splenectomy is sometimes required for severe anaemia or thrombocytopenia.
Splenectomy is performed mainly for:
• Autoimmune thrombocytopenic purpura
• Haemolytic anaemias
• Hodgkin’s disease-staging , although this is less frequently performed as occult abdominal disease can be detected by CT and MRI scanning
IMMEDIATE: increased platelet count (usually 600- 1000 x 109/litre) for 2-3 weeks, thromboembolic phenomena may occur.
LONG-TERM: increased risk of overwhelming infections, particularly pneumococcal infections. Prophylaxis against infection after splenectomy or splenic dysfunction.
All patients should receive a single dose of polyvalent anti pneumococcal vaccine, which should be given 2-3 weeks before splenectomy. It is effective if the types of pneumonia are reflected in the polysaccharides contained in the serum. The vaccine may need to be repeated in 5- 10 years. Long-term prophylactic penicillin is given. Postsplenectomy haematological features
THROMBOCYTOSIS persists in about 30% THE WCC is usually normal but there may be a mild lymphocytosis and monocytosis
ABNORMALITIES IN RED CELL MORPHOLOGY are the most prominent changes and include Howell-Jolly bodies, Pappenheimer bodies, target cells and irregular contracted red cells. Pitted red cells can be counted.
This is seen in sickle cell disease due to infarction. It is also seen in coeliac disease, dermatitis herpetiform is and occasionally in ulcerative colitis and essential thrombocythaemia. Postsplenectomy haematological features are seen.