PA19.4 | Splenomegaly — Causes & Differentiation — Summary & Reflection

REFLECT

Pause and construct your own framework before moving to the summary:

1. A patient in your future surgical posting has massive splenomegaly. Without looking back, list the six causes of massive splenomegaly and one distinguishing feature for each.

1. You are asked: "This patient has portal hypertension and splenomegaly with thrombocytopenia — does the patient have hypersplenism?" What additional piece of information do you need before answering yes?

1. Felty syndrome = RA + splenomegaly + ___. Fill in the blank and explain the mechanism of the missing feature.

Write your answers in your note-pad. Check them against the summary block.

KEY TAKEAWAYS

Key take-aways from PA19.4 — Splenomegaly:

• The spleen has red pulp (filtration/pitting/reservoir) and white pulp (immune/IgM). Extramedullary haematopoiesis resumes in the adult spleen when marrow fails.

• Five mechanistic categories: Congestive → Infective → Haematological → Infiltrative/Storage → Immune.

• Causes of MASSIVE splenomegaly (CML, Myelofibrosis, Kala-azar, Malaria, Gaucher, Thalassaemia major) — remember: size = distinctive feature.

• Hypersplenism = splenomegaly + cytopenias + hypercellular marrow + correction by splenectomy. Marrow is reactive, not suppressed.

• Splenectomy consequences: Howell-Jolly bodies + target cells + thrombocytosis on film; OPSI from S. pneumoniae, H. influenzae, N. meningitidis — vaccinate + prophylactic penicillin.

• Cross-references: H5 (haemolytic anaemias as a cause), H7 (CML/myelofibrosis as massive splenomegaly causes), H8 (lymphoma/leukaemia infiltration).