Splenomegaly at a University Hospital Compared to a Nearby County Hospital in 317 Patients

Abstract

Splenomegaly and massive splenomegaly were diagnostically evaluated retrospectively at Stanford University Hospital in 147 patients over 8 years and compared to the nearby county hospital (Santa Clara Valley Medical Center; VMC) in 170 inpatients over 11 years. Hematologic diseases at Stanford (data for VMC in parentheses) occurred in 66% (35%; p < 0.001) of the patients with splenomegaly and in 84% (54%; p < 0.001) of those with massive splenomegaly. Hepatic diseases occurred in 9% (36%; p < 0.001) of the patients with splenomegaly and in 5% (29%; p < 0.001) of those with massive splenomegaly. Splenectomy was performed in 71% of the patients at Stanford and in 9% of those at VMC (p < 0.001). The combined Stanford-VMC series showed significant associations (p < 0.01): for hematologic diseases with massive splenomegaly, lymphadenopathy, and blood cytoses; for hepatic diseases with hepatomegaly, cytopenias as hypersplenism, and abnormal liver function tests, and for infectious diseases with fever.

Hematology – A diagnostic tool in cases of splenomegaly

“…In the present study, hematological disorders formed an important and most frequent cause (74%) of splenomegaly which was comparable to the study by Nadeem et al [2], O' Reilly RA [6] and Swaroop et al [7] In hematological malignancies, there were maximum number of cases of acute lymphoblastic leukemia (11 cases), followed by acute myeloid leukemia (5 cases) and chronic myeloid leukemia (2 cases). Though chronic myeloid leukemia is the most frequent hematological condition associated with splenomegaly, only few cases were found in the present study.…”

“…The most common cause of hypersplenism in this study was liver cirrhosis (3 cases) followed by non-cirrhotic portal hypertension (1 case). The same experience has been shared by Swaroop et al [7], O'Reilly RA [8] and Sunderesan et al [9], who have shown liver diseases to be the important cause of hypersplenism. Sunderesan et al [9] have shown that there is no statistically significant correlation between degree of splenomegaly and hemoglobin level, total leucocyte count and platelet counts IJBAR (2016) 07 (09) www.ssjournals.com amongst the patients of hypersplenism.…”

“…The most common causes of moderate and massive splenomegaly (Grade III and IV) in the present study were hemolytic anemia, myelofibrosis, chronic myeloid leukemia, liver cirrhosis, non-cirrhotic portal hypertension. Preponderance of hematological diseases in massive splenomegaly is also noted by Swaroop et al [7], O' Reilly R A. [8] One case each of malaria, acute lymphoblastic anemia, acute myeloid leukemia, liver cirrhosis, chronic myelogenous leukemia, dengue, myelofibosis, non-cirrhotic portal hypertension and congenital dyserythropoietic anemia had associated hepatomegaly.…”

Aberrant phenotypes of transgenic mice expressing dimeric human erythropoietin

“…A previous study reported that enhanced erythropoiesis occurred in tg spleens, accompanied by an up to 5-fold increase in weight [20]. In studies of inpatients with splenomegaly, hematological diseases were positively associated with lymphadenopathy, massive splenomegaly, and cytosis (erythrocytosis, leukocytosis, and thrombocytosis) [41,42]. O'Reilly et al [43] reported that 84% of the cases with progressive splenic enlargement were associated with hematological disease, predominantly malignancy.…”

Assessing Splenomegaly

“…Splenomegaly is a nonspecific finding which is diagnostically challenging to assess because the manifestation is nearly always secondary to another primary disorder and diseases associated with the spleen are numerous [1–8]. Pozo et al grouped them into six categories: infection, hematological, congestive, inflammatory, neoplastic and infiltrative miscellaneous diseases [7].…”