Splenomegaly

Definition

Splenomegaly denotes a palpable spleen, or an enlarged spleen detected by US or CT / MRI scan.

Presentation ranges from a massively enlarged spleen to mild splenomegaly only detected on imaging. Increasingly, splenomegaly is noted as an incidental finding in imaging studies performed for other reasons.

Isolated splenomegaly is a feature of a number of diverse problems including:

infections such as malaria and infective endocarditis;
chronic liver disease; autoimmune disorders including rheumatoid arthritis, Felty’s syndrome and SLE;
Gaucher’s disease and sarcoidosis.

Haematological causes include autoimmune haemolysis, hereditary spherocytosis, myeloproliferative disorders, myelofibrosis, leukaemias and lymphomas.

Who to refer, who not to refer, how to refer

Who to refer:

Those with

Splenomegaly >15cms
Significant additional systemic symptoms: weight loss, fever, alcohol-induced pain
Associated nodal enlargement
Increased reticulocyte count and/or DCT positive
Abnormal FBC: either cytopenias or cytoses, lymphocytosis or leucoerythroblastic blood film

Who not to refer:

Those with chronic liver disease and portal hypertension

How to refer:

SCI Gateway to Department BGH

Primary care management

Primary care investigations

FBC
Blood film
CRP
Reticulocyte count, if raised check Direct Antiglobulin Test (DAT) test
LFTs and LDH
Viral serology for EBV (IgM),HIV & Hepatitis viruses
Immunoglobulins and serum electrophoresis

If additional clinical features to suggest a diagnosis of SLE, RA or other connective tissue disorder check CCP, ANA, dsDNA (if ANA positive).

Last reviewed: 17/07/2025

Next review date: 17/07/2027

Author(s): Charlotte Robertson.