The differential diagnostic possibilities are much fewer when the spleen is "massively enlarged," palpable more than 8 cm below the left costal margin or its drained weight is ≥1000 g (Table 60-3). The vast majority of such patients will have non-Hodgkin's lymphoma, chronic lymphocytic leukemia, hairy cell leukemia, chronic myelogenous leukemia, myelofibrosis with myeloid metaplasia, or polycythemia vera. Table 60-3 Diseases Associated with Massive Splenomegalya Chronic myelogenous leukemia Gaucher's disease Lymphomas Chronic lymphocytic leukemia Hairy cell leukemia Sarcoidosis Myelofibrosis metaplasia with myeloid Autoimmune anemia hemolytic Polycythemia vera Diffuse hemangiomatosis splenic a The spleen extends greater than 8 cm below left costal margin and/or . | Chapter 060. Enlargement of Lymph Nodes and Spleen Part 6 The differential diagnostic possibilities are much fewer when the spleen is massively enlarged palpable more than 8 cm below the left costal margin or its drained weight is 1000 g Table 60-3 . The vast majority of such patients will have non-Hodgkin s lymphoma chronic lymphocytic leukemia hairy cell leukemia chronic myelogenous leukemia myelofibrosis with myeloid metaplasia or polycythemia vera. Table 60-3 Diseases Associated with Massive Splenomegaly Chronic myelogenous leukemia Gaucher s disease Lymphomas Chronic lymphocytic leukemia Hairy cell leukemia Sarcoidosis Myelofibrosis with myeloid Autoimmune hemolytic metaplasia anemia Polycythemia vera Diffuse splenic hemangiomatosis The spleen extends greater than 8 cm below left costal margin and or weighs more than 1000 g Laboratory Assessment The major laboratory abnormalities accompanying splenomegaly are determined by the underlying systemic illness. Erythrocyte counts may be normal decreased thalassemia major syndromes SLE cirrhosis with portal hypertension or increased polycythemia vera . Granulocyte counts may be normal decreased Felty s syndrome congestive splenomegaly leukemias or increased infections or inflammatory disease myeloproliferative disorders . Similarly the platelet count may be normal decreased when there is enhanced sequestration or destruction of platelets in an enlarged spleen congestive splenomegaly Gaucher s disease immune thrombocytopenia or increased in the myeloproliferative disorders such as polycythemia vera. The CBC may reveal cytopenia of one or more blood cell types which should suggest hypersplenism. This condition is characterized by splenomegaly cytopenia s normal or hyperplastic bone marrow and a response to splenectomy. The latter characteristic is less precise because reversal of cytopenia particularly granulocytopenia is sometimes not sustained after splenectomy. The cytopenias result from increased destruction of the
