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Haem Exam
Haem Exam
When examining a patient's haematologic system, remember the three key cell lines and the major manifestations that can result from their derangement: anaemia, infection and bleeding / bruising. The haematology exam is also used to identify signs of malignancy, such as lymphadenopathy and splenomegaly.

The Spleen



  • Splenomegaly is present if the spleen is palpable. This may be a sign of portal hypertension due to liver, vascular or pulmonary disease; splenomegaly also occurs with certain infections and haematologic malignancies.
    • How to Elicit

    • Apply gentle pressure to the right lower quadrant. Ask the patient to take a deep breath in. Move the hand superiorly and medially each time the patient breathes out and repeat until the left costal margin is reached. Repeat with the patient in the right lateral decubitus position.
    • Causes of Splenomegaly

    • Congestion - congestive cardiac failure, portal vein thrombosis, cirrhosis
    • Infection - bacterial / viral / parasitic
    • Inflammation - SLE, IBD, rheumatoid arthritis
    • Haematological - leukaemia / lymphoma, thalassaemia, sickle cell anaemia, haemolytic anaemia
    • Systemic - sarcoidosis, amyloidosis
    • Malignancy - leukaemia, lymphoma, splenic tumours, metastases
  • Massive splenomegaly is uncommon and occurs in the setting of CML, myelofibrosis, certain lymphomas, malaria and leichmaniasis.
Last updated on November 25th, 2019