Assessment of Mild Splenomegaly

Definition and Grading

A spleen size of 11-13cm in length is considered mild splenomegaly, according to the Journal of Clinical Oncology and other guidelines 1, 2
The American College of Physicians defines significant splenomegaly as >13cm, which is a threshold for clinically significant splenomegaly 1

Leukocytosis with lymphocytosis and eosinophilia suggests an inflammatory, infectious, or hematologic process, as reported by the Annals of Oncology 3
Anemia is significant and requires further evaluation, according to the Journal of the National Comprehensive Cancer Network 4
Hepatomegaly in conjunction with splenomegaly raises concern for potential hematologic disorders, as noted by the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 3, 4

Lymphoproliferative disorders, such as lymphoma or leukemia, are suggested by anemia, leukocytosis with lymphocytosis, and hepatosplenomegaly, according to the Journal of the National Comprehensive Cancer Network 4
Myeloproliferative neoplasms, such as essential thrombocythemia or primary myelofibrosis, are potential causes of splenomegaly, as reported by the Annals of Oncology 3, 5

A complete blood count with peripheral smear is recommended to evaluate for abnormal cells suggestive of hematologic malignancy, according to the Journal of the National Comprehensive Cancer Network 4
Bone marrow aspiration and biopsy are recommended to evaluate for myeloproliferative disorders, lymphoproliferative disorders, and infiltrative processes, as noted by the Annals of Oncology and the Journal of the National Comprehensive Cancer Network 3, 4
Molecular testing for JAK2, CALR, and MPL mutations is recommended to evaluate for myeloproliferative neoplasms, according to the Annals of Oncology 3

Treatment should be directed at the underlying cause once diagnosed, as recommended by the Praxis Medical Insights 2
Anemia may require transfusion support depending on symptoms and hemodynamic stability, according to the Journal of the National Comprehensive Cancer Network 4
If a myeloproliferative neoplasm is diagnosed, risk stratification and appropriate therapy should be initiated, as reported by the Annals of Oncology 3, 5