This patient has splenomegaly due to hyperviscosity syndrome. She had a relapse of her leukemia and developed tumor lysis syndrome due to her overwhelming tumor burden while in the hospital. She was noted initially to be anemic and thrombocytopenic and later required transfusions of both PRBCs and platelets.
Splenomegaly
On ultrasound, splenomegaly is defined as a longitudinated measurement of the spleen greater than 13 cm (in adults). Although it is not a disease state itself, it is usually a response to underlying pathology. Causes of splenomegaly include: neoplasm or myeloproliferative disorders (lymphomas, leukemias, metastatic disease); infectious processes (TB, EBV, CMV, HIV, Lyme disease, RMSF); portal hypertension or systemic congestion (CHF, cirrhosis); chronic transfusion.
Hypersplenism is indiscriminate destruction of the formed elements of the blood by an enlarged spleen. Any blood line can be affected (erythrocytes, neutrophiles or platelets) alone or in combination. Splenic hypertrophy leads to premature destruction of cells by splenic macrophages, an exaggeration of the spleen's normal function of removing senescent cells. Splenectomy may correct cytopenia.