Causes for a clinically palpable spleen:

• infection
  • acute: septic shock, infective endocarditis, tyhoid, mono
  • chronic - TB
  • parasitic - malaria, schistosomiasis
• inflammation - RA, sarcoisosis, SLE
• haem - haemolytic anaemia, haemoglobinopathies, and the leukaemias, lymphomas and myeloproliferative disorders
• portal HTN - liver disease
• miscellaneous: storage diseases (e.g. Gaucher’s disease), amyloidosis, primary and secondary neoplasias, tropical splenomegaly.

Massive splenomegaly is seen in myelofibrosis, chronic myeloid leukaemia, chronic malaria, kala-azar or, rarely, Gaucher’s disease.

Hypersplenism:

This can result from splenomegaly of any cause. It is commonly seen with splenomegaly due to haematological disorders, portal hypertension, rheumatoid arthritis (Felty’s syndrome) and lym- phoma. Hypersplenism produces:

• pancytopenia
• haemolysis due to sequestration and destruction of red cells in
• the spleen increased plasma volume.

Management

This is often dependent on the underlying cause; splenectomy is sometimes required for severe anaemia or thrombocytopenia.

Splenectomy is usually performed for:

• trauma
• ITP
• haemolytic anaemias