How should splenomegaly be graded?

The spleen is an immune organ. If the spleen is enlarged, it will cause abnormalities in the immune system. The spleen does not grow larger in one day. It is the result of a long period of time and is caused by many reasons. If it is not treated, it will cause more serious consequences, so it needs to be treated in time and do not delay. Splenomegaly is mainly caused by chronic and acute infections. How is spleen enlargement graded?

Acute infection can be seen in acute viral hepatitis, typhus, sepsis, subacute bacterial endocarditis, etc. This type of splenomegaly is mainly mild to moderate, most of which are accompanied by tenderness. It can generally return to normal in a short time after the infection is controlled. Chronic infectious diseases, including schistosomiasis, endocarditis, syphilis, tuberculosis, etc., can cause moderate to severe splenomegaly, with a hard texture. Most patients have a history of living in epidemic areas for a long time. It is generally difficult to return to normal after treatment, especially recurrent infections, which can cause significant enlargement of the spleen. The causes of splenomegaly can be classified into two categories: one is infectious splenomegaly; the other is non-infectious splenomegaly. There are many causes of splenomegaly, and the mechanism by which each disease causes splenomegaly is different. Sometimes the mechanism of splenomegaly caused by one cause may be multiple factors.

Palpation of the spleen is a simple method to determine spleen enlargement. Normally, the spleen cannot be palpated below the left costal margin. When there is visceral ptosis, left-sided pleural effusion or pneumothorax, the lower edge of the spleen can occasionally be felt below the costal margin. The commonly used clinical grading standards for splenomegaly are:

(1) Mild enlargement: When taking a deep breath, the spleen edge does not exceed 2 cm below the ribs. It is common in acute infection, acute leukemia, myelodysplastic syndrome, connective tissue disease, etc.

(2) Moderate enlargement: Moderate enlargement is when the spleen enlarges more than 2 cm below the ribs to above the umbilicus level. It is common in chronic hemolytic anemia, cirrhosis, chronic lymphocytic leukemia, lymphoma, chronic infection, etc.

(3) Severe enlargement: The spleen margin extends below the umbilicus or beyond the anterior midline, also known as giant spleen. It is common in chronic myeloid leukemia, myelofibrosis, kala-azar, schistosomiasis, cirrhosis and lipid deposition disease.

Patients should pay attention to avoiding trauma to the spleen, and have regular blood tests to stimulate the spleen's hematopoietic function and clarify the current status of the spleen through examination. They should also pay attention to rest, avoid strenuous exercise, be optimistic, and eat easily digestible food. High-protein, low-fat food is the principle of food choice for spleen patients.