Journal of Hematology, ISSN 1927-1212 print, 1927-1220 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Hematol and Elmer Press Inc
Journal website http://www.thejh.org

Original Article

Volume 5, Number 3, September 2016, pages 83-93


Splenomegaly in Patients With Sideropenic Anemias: Clinical and Hematologic Significance

Figure

Figure 1.
Figure 1. Causes of sideropenic anemias in the study patients.

Tables

Table 1. Demographic and Clinical Characteristics of the Study Groups (Total n = 108)
 
VariableGroup 1 (n = 53)Group 2 (n = 30)Group 3 (n = 25)P value
Data were presented as mean ± SD or as percentage from the total number.
Demographics
  Age
    Mean ± SD30.89 ± 13.3931.21 ± 15.1531.01 ± 14.010.912
  Gender
    Male25 (47.2%)12 (40%)11 (44%)0.818
    Female28 (52.8%)18 (60%)14 (56 %)
  Residence
    Urban16 (30.2%)17 (56.6%)11 (44%)0.105
    Rural37 (69.8%)13 (43.4%)14 (56%)
  Governorate
    Assiut37 (69.8%)13 (43.3%)11 (44%)
    Qena3 (5.7%)11 (36.7%)2 (8%)
    Sohag0 (0%)6 (20%)0 (0%)0.000**
    Luxor5 (9.4%)0 (0%)8 (32%)
    Al Menia6 (11.3%)0 (0%0 (0%)
    Aswan2 (3.8%)0 (0%)4 (16%)
  Occupation
    Housewife14 (26.4%)9 (30.0%)0 (0%)
    Farmer9 (17%)2 (6.7%)0 (0%)
    Employed9 (17%)10 (33.3%)16 (32.4%)
    Unemployed6 (11.3%)0 (0%)0 (0%)
    Student15 (28.3%)4 (13.3%)9 (36%)
    Retired0 (0%)5 (16.7%)0 (0%)
  Family
    Married8 (15.1%)4 (13.3%)3 (12%)
    Parent20 (37.7%)25 (83.3%)14 (56%)
    Single25 (47.2%)1 (3.3%)8 (32%)
Main complaint
    Pallor, dizziness52 (98.2%)5 (16.7%)0 (0%)
    Repeated vomiting0 (0%)7 (23.3%)0 (0%)
    Non-hematological1 (1.8%)18 (60%)0 (0%)
    Asymptomatic0 (0%)0 (0%)25 (100%)
Nutritional history
  Drinking tea
    Excessive37 (69.8%)15 (50%)9 (36%)0.013
    Mild16 (30.2%)15 (50%)16 (64%)
  Malnutrition
    Not present41 (77.4%)24 (80%)0 (0%)0.037
    Documented12 (22.6%)6 (20%)0 (0%)
Signs
  Pallor53 (100%)28 (93.3%)0 (0%)
  Angular cheilitis24 (45.3%)2 (6.7%)0 (0%)0.000**
  Kiolonychia17 (32.1%)0 (0%)0 (0%)
  Liver
    Impalpable53 (100%)17 (56.7%)25 (100%)0.000**
    Hepatomegaly0 (0%)13 (43.3%)0 (0%)
  Spleen
    No splenomegaly47 (88.7%)18 (60%)25 (100%)
    Grade 00 (0%)6 (20%)0 (0%)0.000**
    Grade 15 (9.4%)6 (20%)0 (0%)
    Grade 21 (1.9%)0 (0%)0 (0%)
  Ultrasound score
    Score 048 (90.5%)20 (66.7%)25 (100%)0.000*
    Score 15 (9.4%)10 (33.3%)0 (0%)

 

Table 2. Laboratory and Hematologic Characteristics of the Study Groups (Total no = 108)
 
ParameterMeanStandard deviationStandard error95% confidence interval for meanMinimumMaximum
Lower boundUpper bound
WBCs: white blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; Plt: platelet; Retic: reticulocyte count; ESR: erythrocytic sedimentation rate; CRP: C-reactive protein. Duration of anemia in months. Data were presented as mean ± SD. P value was significant at 0.05 level.
WBCs (× 103/dL)
  Group 16.272.5760.3545.566.98312
  Group 28.553.2810.5997.329.78415
  Group 37.322.8240.5656.158.49412
Hb (g/dL)
  Group 17.5792.06490.28367.0108.1483.210.0
  Group 28.3871.24120.22667.9238.8506.511.0
  Group 312.631.03190.206412.20613.05811.514.5
Plts (× 103/dL)
  Group 1447.1193.35626.559393.84500.43210923
  Group 2279.679.07914.438250.10309.16155400
  Group 3227.259.63611.927202.62251.86165380
MCV (fL)
  Group 167.3810.3671.42464.5270.234478
  Group 286.334.9430.90384.4988.187794
  Group 386.044.0870.81784.3587.737692
Retic (%)
  Group 11.8401.04540.14361.5512.1280.73.8
  Group 20.9500.56250.10270.7401.1600.22.0
  Group 31.7280.32210.06441.5951.8610.82.5
S. iron (μg/dL)
  Group 124.681.5540.21324.2525.112228
  Group 228.804.8380.88326.9930.612240
  Group 397.5222.6644.53388.16106.8850135
TIBC (μg/dL)
  Group 1389.241.9635.764377.70400.83300480
  Group 2210.246.0248.403193.01227.3913280
  Group 3319.842.3468.644301.99337.76230380
Duration of SA (ms)
  Group 15.257.7461.0643.117.38136
  Group 25.971.7710.3235.316.6329
  Group 30.000.0000.0000.000.0000
ESR (mm/h)
  Group 122.176.3450.87220.4223.921336
  Group 284.7038.8967.10170.1899.2227135
  Group 311.443.7430.7499.9012.98518
CRP
  Group 11.9503.10430.42641.0942.8050.011.0
  Group 223.335.83291.064921.15525.51113.034.0
  Group 31.7522.43240.48650.7482.7560.08.0

 

Table 3. Tukey Multiple Comparison Test of Quantitative Variables of Patients With SAs Compared With the Controls (Total n = 108)
 
Dependent variable(I) Group(J) GroupMean difference (I-J)Standard errorSig.95% confidence interval
Lower boundUpper bound
WBCs: white blood cells; Hb: hemoglobin; MCV: mean corpuscular volume; Plt: platelet; Retic: reticulocyte count; ESR: erythrocytic sedimentation rate; CRP: C-reactive protein. *The mean difference was significant at 0.05 level.
WBCsGroup 3Group 11.0500.6900.285-0.592.69
Group 2-1.2300.7700.251-3.060.60
HbGroup 3Group 15.0528*0.40460.0004.0916.015
Group 24.2453*0.45160.0003.1725.319
PltsGroup 3Group 1-219.892*35.2060.000-303.59-136.19
Group 2-52.39339.2940.380-145.8141.03
MCVGroup 3Group 118.663*1.9380.00014.0623.27
Group 2-0.2932.1630.990-5.444.85
ReticGroup 3Group 1-0.11160.19600.837-0.5770.354
Group 20.7780*0.21870.0020.2581.298
S. ironGroup 3Group 172.841*2.7130.00066.3979.29
Group 268.720*3.0290.00061.5275.92
TIBCGroup 3Group 1-69.389*10.6330.000-94.67-44.11
Group 2109.675*11.8350.00081.53137.82
Duration of SAGroup 3Group 1-5.245*1.3420.000-8.44-2.06
Group 2-5.967*1.4970.000-9.53-2.41
ESRGroup 3Group 1-10.7305.0950.094-22.841.38
Group 2-73.260*5.6870.000-86.78-59.74
CRPGroup 3Group 1-0.19760.95590.977-2.4702.075
Group 2-21.5813*1.06690.000-24.118-19.045

 

Table 4. Degree and Treatment Modalities of SAs in the Study Patients (total n = 83)
 
VariableGroup 1 ( n = 53)Group 2 (n = 30)P value
Degree of anemia
  Non-anemic0 (0%)0 (0%)0.000**
  Mild0 (0%)2 (6.7%)
  Moderate28 (52.8%)24 (80%)
  Severe25 (47.2%)4 (13.3%)
Treatment0.000**
  No treatment0 (0%)9 (30%)
  Parenteral iron11 (20.8%)0 (0%)
  Oral iron40 (75.5%)8 (26.7%)
  Blood transfusion2 (3.8%)5 (16.7%)
  Oral iron + erythropoietin0 (0%)8 (26.7%)

 

Table 5. Diagnostic Performance of US Variables in Predicting Splenomegaly Among Groups 1 and 2
 
Splenomegaly**Sensitivity (95% CI)Specificity (95% CI)Positive predictive value (95% CI)Negative predictive value (95% CI)P value
*P value < 0.05. **No splenomegaly found in group 3.
Group 1 (n = 53)10% (0.04 - 0.23)66.7% (0.13 - 0.98)83% (0.36 - 0.99)4.25% (0.01 - 0.16)0.03*
Group 2 (n = 30)40% (0.22 - 0.61)40% (0.07 - 0.83)76% (0.46 - 0.93)11.7% (0.02 - 0.38)

 

Table 6. Factors Associated With Splenomegaly in Patients With IDA (Total no = 53)
 
VariableNo splenomegaly, 48 (90.6%)Splenomegaly, 5 (9.4%)P value
P value was significant at 0.05 level.
Gender0.060
  Male21 (43.7%)4 (80%)
  Female27 (56.3%)1 (20%)
Residence0.595
  Urban15 (31.2%)1 (20%)
  Rural33 (68.8%)4 (80%)
Nutritional history
  Drinking tea0.405
    Excessive32 (66.7%)5 (100%)
    Mild16 (33.3%)0 (0%)
Malnutrition0.000**
  Not present41 (85.4%)0 (0%)
  Documented7 (14.6%)5 (100%)
Signs
  Angular cheilitis0.060
    Present20 (41.7%)4 (80%)
    Absent28 (58.3%)1 (20%)
  Koilonychias0.000**
    Present11 (22.9%)5 (100%)
    Absent37 (77.1%)0 (0%)
  Liver0.000**
    Impalpable53 (100%)5 (100%)
    Hepatomegaly0 (0%)0 (0%)
Degree of anemia0.000**
  Mild0 (0%)0 (0%)
  Moderate28 (58.3%)0 (0%)
  Severe20 (41.7%)5 (100%)