Splenomegaly

Acceptability at Recruitment

DISCUSS with MO

Acceptability at CT / Work-Up

DISCUSS with MO

Individual at Risk

Donor/ Recipient

Explanation of Condition

When organs are larger than their normal range of sizes, suffix –megaly is added. Splenomegaly is, therefore, enlargement of the spleen, usually greater than 12 cm in diameter. There are multiple reasons why the spleen can be enlarged. This is usually related to the a disease process. Splenomegaly can be transient in response to an external stimulus. Here, the spleen enlarges, but with time, shrinks back to normal size. However, as many of the reasons are irreversible disorders, in most cases the presence of splenomegaly will rule out acceptance of the donor to the register. Please discuss all cases with MO to confirm. Some possible causes of splenomegaly are: malignant bone marrow disorders (myeloproliferative and lymphoprliferative neoplasms), infections (EBV, CMV, malaria, leishmaniasis, HIV, hepatitis), liver conditions causing portal hypertension, Gaucher’s disease, amyloidosis, haemolytic anaemia, autoimmune disorders (rheumatoid arthritis, SLE).

See also [1]

Guidance

Discuss all cases with MO. If splenomegaly has not resolved, consider only accepting for BM harvest donation if underlying condition does not otherwise preclude the donor from donating. Spleen enlarges in > 90% of donors with GCSF stimulation, usually this enlargement does not exceed 2 cm and settles within 14 days. However, donors with enlarged spleen are deemed to be too high risk for PBSC donation as GCSF stimulation can cause extremely serious but rare complication of splenic rupture. There will be causes of splenomegaly that will be transmitted from donor to recipient, for example: Polycythaemia Vera, SLE. However, there are situations where transient splenomegaly will be accepted, for example, once CMV infection has cleared.

Pseudonyms or Related Conditions

Large spleen

Myeloproliferative neoplasms Myeloproliferative Neoplasm - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

EBV Epstein-Barr Virus - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

CMV Cytomegalovirus - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

Malaria Malaria - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

HIV HIV - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

Hepatitis A, B, C, E, of unknown origin Hepatitis A - Anthony Nolan Medical Guidelines (med-guidelines.org.uk), Hepatitis B - Anthony Nolan Medical Guidelines (med-guidelines.org.uk), Hepatitis C - Anthony Nolan Medical Guidelines (med-guidelines.org.uk), Hepatitis E - Anthony Nolan Medical Guidelines (med-guidelines.org.uk), Hepatitis Of Unknown Origin - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

Rheumatoid arthritis Rheumatoid Arthritis - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

SLE Systemic Lupus Erythematosis - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

Gaucher Gaucher Disease - Anthony Nolan Medical Guidelines (med-guidelines.org.uk)

References

Stroncek D, Shawker T, Follmann D, Leitman SF. G-CSF-induced spleen size changes in peripheral blood progenitor cell donors. Transfusion. 2003 May;43(5):609-13. doi: 10.1046/j.1537-2995.2003.00384.x. PMID: 12702182.

Platzbecker U, Prange-Krex G, Bornhäuser M, Koch R, Soucek S, Aikele P, Haack A, Haag C, Schuler U, Berndt A, Rutt C, Ehninger G, Hölig K. Spleen enlargement in healthy donors during G-CSF mobilization of PBPCs. Transfusion. 2001 Feb;41(2):184-9. doi: 10.1046/j.1537-2995.2001.41020184.x. PMID: 11239220.

Version

Version 1, Edition 1

Date of Last Update

4th October 2021