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An enlarged spleen is > 12 - 13 cm in length Usually an incidental finding for e,g on US
weight loss for > 10 % in 6 months night sweats unexplained fever.
FBC Blood film ESR , Clotting screen ,Reticulocytes ( if raised check Direct Antiglobulin test DAT ) U/E , LFT, CRP , Bone profile B12, red cell folate LDH Immunoglobulins , haemoglobinopathy screen , autoimmune screen ( ANA , Rh factor ) , serum ACE Infection screen for e,g HIV, Monospot test , hepatitis serology
Spleen enlargement > 15 cm ( likely haemaological condition ) Constitutional symptoms as weight loss , B symptoms or clinical concerns Abnormal FBC ( as cytopenias or cytoses , lymphocytosis or leucoerythroblastic blood film ) , paraprotein , lymphadenopathy Increased LDH , evidence of haemolysis , high WBC , increased platelet count NICE - unexplained splenomegaly USC referral ( cancer NHL )
REFERENCES
South Tees Hospitals Haematology Handbook https://www.southtees.nhs.uk/content/uploads/Haematology-Handbook-2014-16.pdf
Pozo AL, Godfrey EM, Bowles KM. Splenomegaly: investigation, diagnosis and management. Blood Rev. 2009 May;23(3):105-11. doi: 10.1016/j.blre.2008.10.001. Epub 2008 Dec 4. PMID: 19062140.
Splenomegaly NHS Lothian https://apps.nhslothian.scot/refhelp/Haematology/Splenomegaly#tabs-1
Manchester University NHS Foundation Trust Adult Haematology GP Pathway Guides https://mft.nhs.uk/app/uploads/2020/08/Haematology-GP-Pathway-Guide.pdf
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