Audience

• Highland HSCP 

The size of the spleen is determined by sex, age and height.

We recommend using this calculator to determine the expected spleen size: Calculate by QxMD: Expected spleen size

Mild splenomegaly (14cm or less) is usually not concerning.

Causes

• Liver disease with portal hypertension
• Viral infection g. EBV, CMV
• Other infections g. tuberculosis, infective endocarditis, tropical diseases, syphilis
• Autoimmune diseases g. rheumatoid arthritis
• Metabolic storage disorders e.g. Gaucher’s disease
• Sarcoidosis
• Lymphoma
• Myeloproliferative neoplasms g. chronic myeloid leukaemia, myelofibrosis
• Haemolytic anaemias, thalassaemia/haemoglobinopathies/spherocytosis etc

History and examination

Look at 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, recent viral infection, features of autoimmune disease, family history and travel history. Review any previous imaging.

Suggested investigations

• Full blood count and blood film
• Ultrasound scan of abdomen
• Liver function tests
• 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 and differential diagnosis

Management

• If spleen size is enlarged for height and sex but 14cm or less and no other cause and no suspicion regarding haematological aetiology then suggest repeating ultrasound scan in four to six months to see if resolving and to ensure not increasing in size.
• In the absence of liver disease or infection then if the spleen is persistently enlarged over 14cm or 2cm above predicted or if other features suggesting haematological malignancy then suggest referral to
• Discuss via Clinical Dialogue if concerns