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Forum Name: Hematology Topics

Question: Enlarged Spleen


 Zeeshmanq - Sun Feb 25, 2007 2:52 pm

I m 26 year old, Male, with no apparent illness, prior surgery, or history of medical problems in the family. I have enlarged spleen assessed using Ultrasound with volume of 368 ml, with largest dimension size at 12.6 cm. Here is my blood results:

RBC: 577 ( normal range: 415 - 580 )
HGB: 160 ( normal range: 135 - 175 )
Platelets: 341 ( normal range: 150 - 350)
WBC: 7600 ( normal range: 4,000 - 11,000)
LYMPH#: 2730 ( normal range: 1030 - 3200)
NEUT#: 4320 ( normal range: 1870 - 7000)
MCV: 80 (normal range: 79 - 100)
MCH: 28 (normal range: 27 - 32)
MCHC: 348 (normal range: 320 - 360)
RDW: 11.4 (normal range: 11.5 - 14.0)

My doctor doesn't think anything is wrong. But I am still very worried and think it could be a disease process. I don't have any other symptoms other than mild pain in the spleen that comes and go. I actually went for a complete work up because a week prior to going to the doctor I had 2 days of fever, and pain in my spleen. The fever had by the time I got an appointment resolved itself. For a 26 year old do the above parameters look good to you, and also my triglyceride were kind of high, and my ferratin levels were at 226 (within the normal range). All other tests including urine, liver function, chemistry, and chest x-tray were completely unremarkable.

Could it be possible that there is improper assessment of my spleen's size?
 Dr. Chan Lowe - Wed Feb 28, 2007 10:00 pm

User avatar I would tend to agree with your doctor. Your lab tests are all reassuring that there is nothing major going on. Your symptoms suggest that you had a recent viral infection.

The spleen measurements that you give can be interpreted as mildly to borderline moderately enlarged. This can be do to several reasons. Most commonly, the spleen enlarges as it serves its normal role in helping "filter" the blood of antibodies, etc. that are helping fight off infection. Given your recent cold symptoms, it is likely that you are experiencing a physiologic increase in your spleen size to help it perform its function better. In this case, the spleen will slowly return to normal size, though this may take a few weeks.

Splenic pain can occur with stretching of the capsule (the surrounding "shell" of the spleen) when it enlarges from any cause, including normal enlargement.

If you continue to have ongoing symptoms I recommend that you follow up with your doctor.

Hope this helps.
 bossdiane - Fri Jul 09, 2010 10:08 am

Hi Dr. Chan Lowe,
I read your answer on the Spleen Enlargement due to physiological reasons.
My husband was diagnosed to have a slightly enlarged spleen few years ago, about 3 years ago, if my memory serves me right. We didn't do anything about it until this week because it's giving him pain on his lower left rib. Our doctor took blood and urine test, results were fine but we still have to wait for the Hepatitis test result. The doctor reckons it was just some skin deep problem which is causing the pain.
Please help me understand what could be the possible cause of the pain. What additional test do we need to do? What about the Lymph Nodes, Bone Marrow tests or anything like that?

Thank you,
Diane
 Dr.M.Aroon kamath - Wed Aug 04, 2010 10:44 pm

User avatar Hi bossdiane and Zeeshmanq,
Thought i will let you have some interesting information that i happened to come across. The various possibilities have already been well explained by Dr.Chan Lowe.

Assessment of splenic size becomes necessary in many clinical situations(in adults as well as in children). With the advent of the modern imaging techniques, it has become possible to obtain far more accurate estimates of splenic dimensions. Ultrasonography and CT are the most commonly used imaging techniques. Ultrasonography has the advantage of not involving ionizing radiation.

"Normal" splenic size: In paediatric and adolescent age groups, there are indications of a significant correlation been observed splenic size and height, weight, and body surface area.

Radiological texts differ in defining the upper limits of normal for the longitudinal diameter(length) of the spleen, with values ranging from 12 to 14 cm in adults.
Normal splenic size has been found to vary significantly
depending on age and sex. Overall average for splenic length of 10.65 cm on imaging has been observed in several reports for the general adult population.

Historically, assessment of splenomegaly has been based
on spleen length, as the measurement of splenic width is more difficult and less reliable(more prone to intra-and inter- observer variations in ultrasonography).
Defining splenomegaly on the basis of calculated splenic volume may be more uncertain.

There is marked variation in the ultrasound techniques (patient position, position of the probe etc) used in evaluating the spleen. These contribute to the observed variations in splenic length during assessment.

One study in particular, has come up with the following observations.
- more than 7% of athletes were observed to have a spleen length of >13 cm, - a value that has been traditionally used as a loose cut off point to define splenomegaly.
- As a group, African Americans in that study population had smaller spleens despite being taller and heavier than the white athletes.
- only a moderate correlation was observed between sp
lenic size and anthropometric measurements in the adults studied.
Br J Sports Med 2006;40:251–254. doi: 10.1136/bjsm.2005.022376

Your splenic size has to be interpreted with caution in the light of the available scientific evidence.
Best wishes!

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