Step 1: Perform an abdominal ultrasound.
Step 2: If the spleen is present, then perform a liver-spleen scan with Technetium-99m.
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Abdominal Ultrasound
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Liver-Spleen Scan
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Interpretation
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spleen absent
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N/A
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hyposplenia or asplenia
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spleen present
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normal uptake
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normal splenic function
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spleen present
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no or markedly decreased uptake
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functional hyposplenism or functional asplenia
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Causes of hyposplenia or asplenia:
(1) splenectomy (a person with a history of splenectomy may have some residual splenic function if a partial resection, multiple spleens or splenosis are present.
(2) congenital asplenia
(3) post-radiation splenic atrophy
If the spleen is present and splenic function is normal, then evaluate the patient for other causes of abnormal red blood cell morphology, including
(1) megaloblastic anemias
(2) hemolytic anemia
If functional hyposplenism/asplenia is present, then try to determine the cause:
(1) potentially reversible: infection, therapy-related, etc.
(2) irreversible: infarction, replacement, etc.
