Page 467 - Medicine and Surgery

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Haematology and clinical 12

immunology

Clinical, 463 Myelodysplastic and Bleeding disorders, 492
Haemoglobin disorders and myeloproliferative disorders, 481 Transfusion medicine, 496
anaemia, 467 Leukaemia and lymphoma, 485 Clinical immunology, 498
Malaria, 480 Paraproteinaemias, 490 HIV, 501

Splenomegaly
Clinical
The spleen is not normally palpable on clinical exami-
nation. The spleen may by moderately or massively en-
Signs larged see Table 12.2.
Hypersplenism occurs when the spleen is func-
Lymphadenopathy tionally overactive and can result from any cause of
splenomegaly. It causes pancytopenia and haemolysis.
The usual function of lymph nodes is to allow anti-
gen recognition, proliferation and affinity maturation
of mature lymphocytes. They usually become enlarged Bleeding tendency
when active/reactive because of infection. Enlargement
of lymph nodes can be localised or generalised (see Ta- Characterisation of a bleeding tendency requires multi-
ble 12.1). ple tests; however, a number of important factors can be
elucidated clinically.
Differentiating between an inherited or acquired dis-

Table 12.1 Causes of lymphadenopathy ordermaybesuggestedbytheage.Afullfamilyhistory
is also essential to establish any affected relatives.
Localised lymphadenopathy
Generalised haemostatic defects are suggested by
Infection, e.g. cervical lymphadenopathy in tonsillitis,
lymphadenitis bleeding from multiple sites, spontaneous bleeding
Carcinoma, e.g. lymph node enlargement in the axilla and bleeding into the skin.
with breast carcinoma
Hodgkin’s disease (can also be generalised)
Non-Hodgkin’s lymphoma (can also be generalised) Table 12.2 Causes of splenomegaly
Tuberculosis can present as a single enlarged painless
lymph node Moderate splenomegaly Massive Splenomegaly
Sarcoidosis often begins with bilateral hilar Infectious mononucleosis Chronic myeloid leukaemia
lymphadenopathy Septicaemia, infective Myelofibrosis
Generalised lymphadenopathy endocarditis
Infectious mononucleosis Hodgkin’s disease, Storage disorders such as
Toxoplasmosis non-Hodgkin’s lymphoma Gaucher’s disease
Human immunodeficiency virus can cause a Leukaemia
persistent generalised lymphadenopathy Haemoglobinopathies
Chronic lymphocytic leukaemia Cirrhosis with portal
Lymphoma hypertension

463