Splenomegaly

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Abstract
SPLENOMEGALY may be a presenting or dominant feature of certain diseases. Since the spleen enlarges in many conditions, a systematic approach may facilitate timely and costeffective diagnosis of the cause of splenomegaly. The algorithms herein attempt to present a rational, stepby-step diagnostic approach. They consider the causes of splenomegaly in the rough order of their frequency, and they stress clues from the history, physical examination, and routine laboratory test results. Normal Functions of the Spleen In many instances, the spleen enlarges as it performs its normal functions. The four most important normal functions of the spleen are (1) clearance of microorganisms and particulate antigens from the bloodstream; (2) synthesis of immunoglobulin and properdin factors; (3) destruction of effete or abnormal RBCs; and (4) embryonic hematopoiesis, which can reactivate as extramedullary hematopoiesis in certain diseases. Mechanisms of Splenomegaly There are six basic pathophysiological mechanisms of splenomegaly: (1) immune response "work hypertrophy,"

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