Leukemia (with Splenomegaly)

From WebHealth

[edit] Leukemia (with splenomegaly)

Introduction:

In many lymphoproliferative disorders such as leukemia, lymphomas and severe infections such as Epstein Barr virus (= mononucleosis) the spleen can be enlarged to several times the normal size. This enlargement of the spleen is medically called " splenomegaly ". The spleen removes red blood cells that are older than 120 days and also old platelets.

The balance can tip and a condition of " hypersplenism" can develop, where one or more of the blood cell types are filtered out by the spleen: red blood cells (causing anemia), white blood cells (causing leukopenia) or platelets (causing thrombocytopenia). This condition calls for a referral to a hematologist to sort out the cause behind this condition and to treat it.

Symptoms:

The symptoms can be quite varied depending on the underlying cause of the hypersplenism. If there is a leukemia as the underlying cause, then there would be weight loss and weakness with a high blood cell count, but missing platelets and red blood cells in the blood tests.

With a connective tissue disease such as lupus(=systemic lupus erythematosus) there would be joint involvement and possible skin lesions as well as typical blood titres (positive ANA titre). In all of the diseases with an enlarged spleen there would be left upper abdominal pain and breathing with the left lung may be labored due to the diaphragm finding it hard to move against the massive spleen. With thrombocytopenia pin point bleeding of the skin is common(=petechial bleeding). With low white blood cell counts (leukopenia) there is a danger of infections. Anemia presents as tiredness, lack of energy, increased infection rates and delayed wound healing. With cirrhosis of the liver, where the spleen can get congested (=congested splenomegaly), there is an increased risk for bleeding from esophageal varices.

Treatment:

Treatment has to be individualized for each patient and is directed against the underlying cause to the largest extend and against the symptoms of hypersplenism to a minor extend, depending on the symptomatology. It is a good idea to have a hematologist involved as often the whole hematological system has to be assessed including the bone marrow and not only the spleen. One of the problems can be a ruptured spleen (see above).

Home page

Abdominal pain

References:

1. DM Thompson: The 46^th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".

6. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".

7. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".

8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.