A description of splenomegaly in a hospital haematology setting

Abstract

Background This study entails a retrospective review and description of splenomegaly in a Hospital Haematology setting. Underlying diagnoses and radiological classification, as well as laboratory parameters were used to further describe the splenomegaly encountered in the Clinical Haematology Unit, Department of Medicine, at Chris Hani Baragwanath Academic Hospital over a 10-year period. There is a paucity of data with regards to the occurrence of splenomegaly associated specifically with haematological disorders in the South African context. This study aims to better define the clinical, radiological, and laboratory parameters associated with splenomegaly in the setting of haematological disorders encountered in a hospital setting. Patients and Methods This study is a retrospective review of adult patients seen at the Clinical Haematology Unit, Department of Medicine at Chris Hani Baragwanath Academic Hospital during a 10-year period (01/01/2004 to 31/12/2013). The aim of the study was to determine the profile of patients who presented with splenomegaly, in particular to assess the demographics, clinical presentation, radiological and laboratory findings in association with splenomegaly. A total of 1976 files were reviewed. Splenomegaly was evident in 367 patients (15,6%), who were included in the study. There were 194 males (52,8%) and 173 females (47,2%), with a male to female ratio of 1,38:1. Results and Discussion In keeping with other studies on the subject of splenomegaly within a haematological setting, the vast majority of patients included in this study had neoplasms of the myeloid (43,3%) and lymphoid (16,6%) lineage, which together accounted for 89% of all patients. Myeloid neoplasms that were complicated by splenomegaly include CML (89,4%), PMF (100%), PRV (61,5%), ET (44,4%), while lymphoid neoplasms that manifested with splenomegaly include NHL (14,9%), HL (21,1%), CLL (45,9%) and ALL (17%). Interestingly, the traditional haematological aetiologies of splenomegaly such as sickle cell anaemia and thalassaemia did not contribute to the numbers of patients included in the study. Within the lymphoid neoplasm group in particular, the association with HIV seropositivity remained strong. This was not the case for neoplasms of the myeloid lineage. Conclusion There is currently no South African data available regarding the detection and quantification of splenomegaly specifically with regard to underlying haematological disorders. Traditional haematological causes of splenomegaly may not be entirely applicable to the African population, as the added impact of (HIV) on the profile of local hematological disorders within the African continent may not be considered. With this paucity of information, there is currently no knowledge on the reproducibility of studies relating to the relative frequencies of haematological aetiologies leading to splenomegaly. However, the results from this study clearly demonstrate the overlap in the South African setting between predominantly neoplastic and infectious (including HIV-associated malignancies) aetiologies. These results may be extrapolated to better define the haematological settings in which splenomegaly is encountered in the South African context. Finally, as the study was conducted in a haematology setting, other causes of splenomegaly that may generally not be encountered in haematology patients such as TB, schistosomiasis, portal hypertension, infiltrative disorders and storage diseases do not feature in this review.