From the Guidelines
Workup for Splenomegaly
A thorough workup for splenomegaly is essential to determine the underlying cause, and it should include a complete blood count (CBC) with differential, platelet count, and reticulocyte count to evaluate for cytopenias, anemia, or thrombocytopenia 1.
- Liver function tests (LFTs), including aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, and total and direct bilirubin, should also be conducted to assess liver function and potential liver-spleen axis involvement.
- Imaging studies, such as abdominal ultrasound or computed tomography (CT) scan, are crucial for evaluating spleen size, morphology, and potential focal lesions, and may be useful under certain circumstances, such as in the workup for hairy cell leukemia 1.
- A bone marrow biopsy with or without aspirate should be obtained, especially if lymphoma or leukemia is suspected, as it is a key component of the initial workup for hairy cell leukemia 1.
- Infectious disease workup may include testing for mononucleosis (e.g., monospot test), toxoplasmosis, and other relevant infections based on clinical suspicion and exposure history.
- Testing for autoimmune disorders, such as lupus or rheumatoid arthritis, may be warranted based on clinical presentation.
- A peripheral blood smear can help identify abnormalities in red and white blood cells, and a Coombs test can be performed to evaluate for autoimmune hemolytic anemia.
- It is also important to consider the patient's travel history, exposure to infectious agents, and any underlying medical conditions that may contribute to spleen enlargement.
- A thorough physical examination, including palpation of the spleen, and a detailed medical history are essential components of the workup.
- The workup may also include testing for portal hypertension, such as esophagogastroduodenoscopy (EGD) to evaluate for varices, and measurement of portal vein pressure if necessary.
- Hepatitis B virus (HBV) testing is recommended due to the increased risk of viral reactivation associated with the use of immunotherapy and/or chemotherapy 1. Ultimately, the specific tests and procedures will depend on the patient's clinical presentation, medical history, and physical examination findings.
From the Research
Workup for Splenomegaly
The workup for splenomegaly involves a combination of clinical evaluation, laboratory tests, and imaging studies. Some key points to consider in the workup include:
- Clinical history and physical examination to identify underlying causes of splenomegaly, such as liver disease, hematologic disorders, or infection 2
- Laboratory tests, including complete blood count, liver function tests, and coagulation studies, to evaluate for underlying conditions that may be contributing to splenomegaly 3, 4
- Imaging studies, such as abdominal ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI), to assess spleen size and morphology, as well as to evaluate for other abdominal pathology 3, 4
Diagnostic Considerations
Some key diagnostic considerations in the workup for splenomegaly include:
- Portal hypertension, which can be assessed using non-invasive splenic parameters such as spleen stiffness, area, and diameter 4
- Thrombosis, which may be more common in patients with splenomegaly, particularly those with essential thrombocythemia 5
- Lymphoproliferative disorders, which can cause splenomegaly and may require biopsy for diagnosis 2
Role of Biopsy
Spleen biopsy may be considered in certain cases, such as:
- Diagnostic uncertainty after clinical and imaging evaluation 2
- Suspected lymphoproliferative disorder or other hematologic malignancy 2
- Evaluation of splenic tissue for underlying conditions such as amyloidosis or storage diseases 2
Imaging and Laboratory Tests
Some key imaging and laboratory tests that may be used in the workup for splenomegaly include:
- Abdominal ultrasound to assess spleen size and morphology 3, 4
- CT scan or MRI to evaluate for other abdominal pathology and to assess spleen size and morphology 3, 4
- Complete blood count to evaluate for underlying hematologic disorders 3, 4
- Liver function tests to evaluate for underlying liver disease 3, 4
- Coagulation studies to evaluate for underlying coagulopathy 3, 4