Splenomegaly (Guidelines) | Right Decisions

Right Decisions
TAM (Treatments and Medicines) NHS Highland
ADULT THERAPEUTIC GUIDELINES
Back
HAEMATOLOGY
Splenomegaly (Guidelines)

Announcements and latest updates

Welcome to the Right Decision Service (RDS) newsletter for August 2024.

Contingency planning for RDS outages

Following the recent RDS outages, Tactuum and the RDS team have been reviewing the learning from these incidents. We are committed to doing all we can to ensure a positive outcome by strengthening the RDS to make it fully robust and clinically resilient for the future.

We would like to invite you to a webinar on 26^th September 3-4 pm on national and local contingency planning for future RDS outages. Tactuum and the RDS team will speak about our business continuity plans and the national contingency arrangements we are putting in place. This will also be a space to share local contingency plans, ideas and existing good practice. We would also like to gather your views on who we should send communications to in the event of future outages.

I have sent a meeting request for this date to all editors – please accept or decline to indicate attendance, and please forward on to relevant contacts. You can also contact Olivia.graham@nhs.scot directly to register your interest in participating.

2.National IV fluid prescribing calculator

This UK CA marked calculator is now live at https://righdecisions.scot.nhs.uk/ivfluids . It has been developed by a multiprofessional steering group of leads in IV fluids management, as part of the wider Modernising Patient Pathways Programme within the Centre for Sustainable Delivery. It aims to address a known cause of clinical error in hospital settings, and we hope it will be especially useful to the new junior doctors who started in August.

Please do spread the word about this new calculator and get in touch with any questions.

New toolkits

The following toolkits are now live;

Gender identity healthcare: adults and young people standards. (https://rightdecisions.scot.nhs.uk/genderidentity ) Note that this toolkit includes self-evaluation forms for each standard. A Scottish Government launch of these standards, together with the toolkit and NES educational resources, is planned for 3^rd September.
Care Inspectorate staffing method framework.
Vascular surgery pathways from the Modernising Patient Pathways Programme within the Centre for Sustainable Healthcare Delivery.

Updated guidance on current and future Medical Device Regulations

We have updated and simplified this guidance within our standard operating procedures. We have clarified the guidance on how to determine whether an RDS tool is a medical device, and have provided an interactive powerpoint slideset to steer you through the process.

Guide to six stages of RDS toolkit development

We have developed a guide to support editors and toolkit leads through the process of scoping, designing, delivering, quality assuring and implementing a new RDS toolkit. We hope this will help in project planning and in building shared understanding of responsibilities throughout the full development process. The guide emphasises that the project does not end with launch of the new toolkit. Implementation, communication and evaluation are ongoing activities throughout the lifetime of the toolkit.

Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

Thursday 5 September 1-2 pm
Wednesday 24 September 4-5 pm
Friday 27 September 12-1 pm

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

7 Evaluation projects

Dr Stephen Biggart from NHS Lothian has kindly shared with us the results of a recent survey of use of the Edinburgh Royal Infirmary of Edinburgh Anaesthesia toolkit. This shows that the majority of consultants are using it weekly or monthly, mainly to access clinical protocols, with a secondary purpose being education and training purposes. They tend to find information by navigating by specialty rather than keyword searching, and had some useful recommendations for future development, such as access to quick reference guidance.

We’d really appreciate you sharing any other local evaluations of RDS in this way – it all helps to build the evidence base for impact.

If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

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

Last reviewed: 29/01/2024

Next review date: 31/01/2027

Author(s): Haematology Department .

Version: 2

Approved By: APPROVED TAM Subgroup of the ADTC

Reviewer name(s): Dr P Forsyth, Consultant Haematologist .

Document Id: TAM617