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Splenomegaly (Viva (Haematological Ix (FBC (CML: ↑↑↑WBC – PMN, basophils,…

- - - - FBC
      - LFT
        
        Clotting
        
        Liver screen
    - - Abdo US + PV duplex
  - - - CML: ↑↑↑WBC – PMN, basophils, myelocytes
      - MF: pancytopenia
      - CLL: lymphocytosis
      - Haemolysis: ↓ Hb, ↑MCV, ↑RDW
    - - MF: leukoerythroblastic w/ teardrop poikiolcytes
      - CLL: smear cells
      - Haemolysis: spherocytes, reticulocytosis
    - - DAT
      - U+E and urate: ↑ malignancy → uropathy
    - - Abdo US
      - CT chest and abdomen
      - PET scan
    - - LN biopsy
      - BM aspirate or trephine biopsy (MF)
    - - CML: Ph Chr, t(9:22)
      - MF: Jak2+ in 50%
  - - - Haematuria: IE
    - - FBC: lymphocytosis (may be atypical in EBV)
      - U+E: renal impairment in IE
      - Thick and thin films
    - - Abdo US
      - Echo: IE
- - - - Haem: pallor, bruising, LNs
      - CLD
      - IE: splinters, clubbing
      - RA hands: Felty’s Syndrome
      - Hepatomegaly
  - - - Haematological: pallor, bruising, purpura, LNs, cachexia
        Cervical, axilla, inguinal
      - Portal HTN: CLD signs
      - IE: splinter’s, clubbing
      - Felty’s Syndrome: rheumatoid hands
  - - - Splenomegaly
        
        Can’t get above it
        Moves inferiorly toward RIF on respiration
        Notch
        Dull PN
        Not ballotable
      - Size: big or small?
      - Hepatomegaly?
      - Inguinal nodes?
- - - - Haem: myelo- / lympho-prolif disorders, haemolysis
      - Portal HTN: mostly 2O to cirrhosis
      - Infection: EBV
    - - Infection: herpes viruses, hepatitis virus, IE, malaria
      - Inflammation: RA, SLE, Sjogren’s
      - Rare: sarcoidosis, amyloidosis, Gaucher’s, CVID
- - - - Pneumovax
        HiB
        Men C
        Yrly flu
- - - - → >90% haematological response
      - 80% 5ys
    - - Indicated if blast crisis or TK-refractory
  - - - PMN and basophils
        Myelocytes