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The spleen must be enlarged to about three times its normal size before it becomes clinically palpable. The lower margin may feel notched on palpation. The spleen may become so massive in size that it is palpable in the right iliac fossa. Massive splenomegaly in the UK is likely to be due to chronic myeloid leukaemia, myelofibrosis or lymphoma. Splenomegaly may lead to hypersplenism, i.e. pancytopenia as cells become trapped and destroyed in an overactive spleen.
Typhoid
Tuberculosis
Leptospirosis
Septicaemia
Abscess
Infectious mononucleosis syndromes (EBV/CMV)
Malaria • (common in Africa)
Hydatid cyst
Rheumatoid arthritis (Felty’s syndrome)
Sarcoidosis
Lupus
Amyloid
Metastases
Primary tumours
Leukaemia ( Fig. 55 )
Lymphoma
Polycythaemia vera
Myelofibrosis
Hereditary spherocytosis
Acquired haemolytic anaemia
Thrombocytopenic purpura
Gaucher’s disease
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