Disorders that causes splenomegaly

Splenomegaly

• The spleen is frequently involved secondarily in systemic diseases and responds by enlarging

Massive (>1000 g)	Moderate (500–1000 g)	Mild (<500 g)
Myeloproliferative disorders (CML, MF); Lymphomas; CLL and hairy cell leukemia; Malaria; Gaucher disease; Primary splenic tumor (rare)	Chronic congestive splenomegaly (portal HTN / splenic vein obstruction); Acute leukemias; Hereditary spherocytosis; Thalassemia major; Autoimmune hemolytic anemia; Amyloidosis; Chronic splenitis; TB, sarcoidosis, typhoid; Metastatic carcinoma/sarcoma	Acute splenitis (bacteremia; liquid parenchyma); Acute splenic congestion; Mononucleosis infectiosa; Miscellaneous acute disorders (septicemia, SLE, intra-abdominal infections)

Consequences of chronic splenomegaly

• Removes excessive formed blood elements → anemia, leukopenia, thrombocytopenia (= hypersplenism)
• Platelets are susceptible to sequestration in the red pulp → worsened thrombocytopenia
• Risk of splenic rupture

---

Hypersplenism

• ≠ splenomegaly: specifically = increased removal of cellular blood components
• Causes:
  • Widening of splenic cords → premature destruction of normal blood cells (portal hypertension, leukemia/lymphoma)
  • Infections: Brucellosis, CMV, mononucleosis, malaria, toxoplasmosis, TB
  • Abnormal blood components (hereditary spherocytosis)

---

Ruptured Spleen

• Medical emergency — life-threatening internal bleeding
• Usually due to blunt force trauma to the abdomen; rarely from acute splenomegaly
• Small capsular tear at superior pole or hilum
• Symptoms: pain and tenderness in upper left abdomen, dizziness, confusion

💡 High-yield: Massive splenomegaly → MPNs, lymphomas, CLL, malaria, Gaucher. Hypersplenism = ↑ removal of blood elements (distinct from splenomegaly). Ruptured spleen = emergency; blunt trauma; capsular tear at superior pole/hilum.