J Hematol

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

**Table 1.** Demographic and Clinical Characteristics of the Study Groups (Total n = 108)
Variable	Group 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 ± SD	30.89 ± 13.39	31.21 ± 15.15	31.01 ± 14.01	0.912
Gender
Male	25 (47.2%)	12 (40%)	11 (44%)	0.818
Female	28 (52.8%)	18 (60%)	14 (56 %)
Residence
Urban	16 (30.2%)	17 (56.6%)	11 (44%)	0.105
Rural	37 (69.8%)	13 (43.4%)	14 (56%)
Governorate
Assiut	37 (69.8%)	13 (43.3%)	11 (44%)
Qena	3 (5.7%)	11 (36.7%)	2 (8%)
Sohag	0 (0%)	6 (20%)	0 (0%)	0.000**
Luxor	5 (9.4%)	0 (0%)	8 (32%)
Al Menia	6 (11.3%)	0 (0%	0 (0%)
Aswan	2 (3.8%)	0 (0%)	4 (16%)
Occupation
Housewife	14 (26.4%)	9 (30.0%)	0 (0%)
Farmer	9 (17%)	2 (6.7%)	0 (0%)
Employed	9 (17%)	10 (33.3%)	16 (32.4%)
Unemployed	6 (11.3%)	0 (0%)	0 (0%)
Student	15 (28.3%)	4 (13.3%)	9 (36%)
Retired	0 (0%)	5 (16.7%)	0 (0%)
Family
Married	8 (15.1%)	4 (13.3%)	3 (12%)
Parent	20 (37.7%)	25 (83.3%)	14 (56%)
Single	25 (47.2%)	1 (3.3%)	8 (32%)
Main complaint
Pallor, dizziness	52 (98.2%)	5 (16.7%)	0 (0%)
Repeated vomiting	0 (0%)	7 (23.3%)	0 (0%)
Non-hematological	1 (1.8%)	18 (60%)	0 (0%)
Asymptomatic	0 (0%)	0 (0%)	25 (100%)
Nutritional history
Drinking tea
Excessive	37 (69.8%)	15 (50%)	9 (36%)	0.013
Mild	16 (30.2%)	15 (50%)	16 (64%)
Malnutrition
Not present	41 (77.4%)	24 (80%)	0 (0%)	0.037
Documented	12 (22.6%)	6 (20%)	0 (0%)
Signs
Pallor	53 (100%)	28 (93.3%)	0 (0%)
Angular cheilitis	24 (45.3%)	2 (6.7%)	0 (0%)	0.000**
Kiolonychia	17 (32.1%)	0 (0%)	0 (0%)
Liver
Impalpable	53 (100%)	17 (56.7%)	25 (100%)	0.000**
Hepatomegaly	0 (0%)	13 (43.3%)	0 (0%)
Spleen
No splenomegaly	47 (88.7%)	18 (60%)	25 (100%)
Grade 0	0 (0%)	6 (20%)	0 (0%)	0.000**
Grade 1	5 (9.4%)	6 (20%)	0 (0%)
Grade 2	1 (1.9%)	0 (0%)	0 (0%)
Ultrasound score
Score 0	48 (90.5%)	20 (66.7%)	25 (100%)	0.000*
Score 1	5 (9.4%)	10 (33.3%)	0 (0%)

Table 1. Demographic and Clinical Characteristics of the Study Groups (Total n = 108)

Variable

Group 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 ± SD

30.89 ± 13.39

31.21 ± 15.15

31.01 ± 14.01

0.912

Gender

Male

25 (47.2%)

12 (40%)

11 (44%)

0.818

Female

28 (52.8%)

18 (60%)

14 (56 %)

Residence

Urban

16 (30.2%)

17 (56.6%)

11 (44%)

0.105

Rural

37 (69.8%)

13 (43.4%)

14 (56%)

Governorate

Assiut

37 (69.8%)

13 (43.3%)

11 (44%)

Qena

3 (5.7%)

11 (36.7%)

2 (8%)

Sohag

0 (0%)

6 (20%)

0 (0%)

0.000**

Luxor

5 (9.4%)

0 (0%)

8 (32%)

Al Menia

6 (11.3%)

0 (0%

0 (0%)

Aswan

2 (3.8%)

0 (0%)

4 (16%)

Occupation

Housewife

14 (26.4%)

9 (30.0%)

0 (0%)

Farmer

9 (17%)

2 (6.7%)

0 (0%)

Employed

9 (17%)

10 (33.3%)

16 (32.4%)

Unemployed

6 (11.3%)

0 (0%)

Student

15 (28.3%)

4 (13.3%)

9 (36%)

Retired

0 (0%)

5 (16.7%)

0 (0%)

Family

Married

8 (15.1%)

4 (13.3%)

3 (12%)

Parent

20 (37.7%)

25 (83.3%)

14 (56%)

Single

25 (47.2%)

1 (3.3%)

8 (32%)

Main complaint

Pallor, dizziness

52 (98.2%)

5 (16.7%)

0 (0%)

Repeated vomiting

0 (0%)

7 (23.3%)

0 (0%)

Non-hematological

1 (1.8%)

18 (60%)

0 (0%)

Asymptomatic

0 (0%)

25 (100%)

Nutritional history

Drinking tea

Excessive

37 (69.8%)

15 (50%)

9 (36%)

0.013

Mild

16 (30.2%)

15 (50%)

16 (64%)

Malnutrition

Not present

41 (77.4%)

24 (80%)

0 (0%)

0.037

Documented

12 (22.6%)

6 (20%)

0 (0%)

Signs

Pallor

53 (100%)

28 (93.3%)

0 (0%)

Angular cheilitis

24 (45.3%)

2 (6.7%)

0 (0%)

0.000**

Kiolonychia

17 (32.1%)

0 (0%)

Liver

Impalpable

53 (100%)

17 (56.7%)

25 (100%)

0.000**

Hepatomegaly

0 (0%)

13 (43.3%)

0 (0%)

Spleen

No splenomegaly

47 (88.7%)

18 (60%)

25 (100%)

Grade 0

0 (0%)

6 (20%)

0 (0%)

0.000**

Grade 1

5 (9.4%)

6 (20%)

0 (0%)

Grade 2

1 (1.9%)

0 (0%)

Ultrasound score

Score 0

48 (90.5%)

20 (66.7%)

25 (100%)

0.000*

Score 1

5 (9.4%)

10 (33.3%)

0 (0%)

**Table 2.** Laboratory and Hematologic Characteristics of the Study Groups (Total no = 108)
Parameter	Mean	Standard deviation	Standard error	95% confidence interval for mean	Minimum	Maximum
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 1	6.27	2.576	0.354	5.56	6.98	3	12
Group 2	8.55	3.281	0.599	7.32	9.78	4	15
Group 3	7.32	2.824	0.565	6.15	8.49	4	12
Hb (g/dL)
Group 1	7.579	2.0649	0.2836	7.010	8.148	3.2	10.0
Group 2	8.387	1.2412	0.2266	7.923	8.850	6.5	11.0
Group 3	12.63	1.0319	0.2064	12.206	13.058	11.5	14.5
Plts (× 10³/dL)
Group 1	447.1	193.356	26.559	393.84	500.43	210	923
Group 2	279.6	79.079	14.438	250.10	309.16	155	400
Group 3	227.2	59.636	11.927	202.62	251.86	165	380
MCV (fL)
Group 1	67.38	10.367	1.424	64.52	70.23	44	78
Group 2	86.33	4.943	0.903	84.49	88.18	77	94
Group 3	86.04	4.087	0.817	84.35	87.73	76	92
Retic (%)
Group 1	1.840	1.0454	0.1436	1.551	2.128	0.7	3.8
Group 2	0.950	0.5625	0.1027	0.740	1.160	0.2	2.0
Group 3	1.728	0.3221	0.0644	1.595	1.861	0.8	2.5
S. iron (μg/dL)
Group 1	24.68	1.554	0.213	24.25	25.11	22	28
Group 2	28.80	4.838	0.883	26.99	30.61	22	40
Group 3	97.52	22.664	4.533	88.16	106.88	50	135
TIBC (μg/dL)
Group 1	389.2	41.963	5.764	377.70	400.83	300	480
Group 2	210.2	46.024	8.403	193.01	227.39	13	280
Group 3	319.8	42.346	8.644	301.99	337.76	230	380
Duration of SA (ms)
Group 1	5.25	7.746	1.064	3.11	7.38	1	36
Group 2	5.97	1.771	0.323	5.31	6.63	2	9
Group 3	0.00	0.000	0.000	0.00	0.00	0	0
ESR (mm/h)
Group 1	22.17	6.345	0.872	20.42	23.92	13	36
Group 2	84.70	38.896	7.101	70.18	99.22	27	135
Group 3	11.44	3.743	0.749	9.90	12.98	5	18
CRP
Group 1	1.950	3.1043	0.4264	1.094	2.805	0.0	11.0
Group 2	23.33	5.8329	1.0649	21.155	25.511	13.0	34.0
Group 3	1.752	2.4324	0.4865	0.748	2.756	0.0	8.0

Table 2. Laboratory and Hematologic Characteristics of the Study Groups (Total no = 108)

Parameter

Mean

Standard deviation

Standard error

95% confidence interval for mean

Minimum

Maximum

Lower bound

Upper 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 1

6.27

2.576

0.354

5.56

6.98

Group 2

8.55

3.281

0.599

7.32

9.78

Group 3

7.32

2.824

0.565

6.15

8.49

Hb (g/dL)

Group 1

7.579

2.0649

0.2836

7.010

8.148

3.2

10.0

Group 2

8.387

1.2412

0.2266

7.923

8.850

6.5

11.0

Group 3

12.63

1.0319

0.2064

12.206

13.058

11.5

14.5

Plts (× 10³/dL)

Group 1

447.1

193.356

26.559

393.84

500.43

210

923

Group 2

279.6

79.079

14.438

250.10

309.16

155

400

Group 3

227.2

59.636

11.927

202.62

251.86

165

380

MCV (fL)

Group 1

67.38

10.367

1.424

64.52

70.23

Group 2

86.33

4.943

0.903

84.49

88.18

Group 3

86.04

4.087

0.817

84.35

87.73

Retic (%)

Group 1

1.840

1.0454

0.1436

1.551

2.128

0.7

3.8

Group 2

0.950

0.5625

0.1027

0.740

1.160

0.2

2.0

Group 3

1.728

0.3221

0.0644

1.595

1.861

0.8

2.5

S. iron (μg/dL)

Group 1

24.68

1.554

0.213

24.25

25.11

Group 2

28.80

4.838

0.883

26.99

30.61

Group 3

97.52

22.664

4.533

88.16

106.88

135

TIBC (μg/dL)

Group 1

389.2

41.963

5.764

377.70

400.83

300

480

Group 2

210.2

46.024

8.403

193.01

227.39

280

Group 3

319.8

42.346

8.644

301.99

337.76

230

380

Duration of SA (ms)

Group 1

5.25

7.746

1.064

3.11

7.38

Group 2

5.97

1.771

0.323

5.31

6.63

Group 3

0.00

0.000

0.00

ESR (mm/h)

Group 1

22.17

6.345

0.872

20.42

23.92

Group 2

84.70

38.896

7.101

70.18

99.22

135

Group 3

11.44

3.743

0.749

9.90

12.98

CRP

Group 1

1.950

3.1043

0.4264

1.094

2.805

0.0

11.0

Group 2

23.33

5.8329

1.0649

21.155

25.511

13.0

34.0

Group 3

1.752

2.4324

0.4865

0.748

2.756

0.0

8.0

**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) Group	Mean difference (I-J)	Standard error	Sig.	95% confidence interval
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.
WBCs	Group 3	Group 1	1.050	0.690	0.285	-0.59	2.69
Group 2	-1.230	0.770	0.251	-3.06	0.60
Hb	Group 3	Group 1	5.0528*	0.4046	0.000	4.091	6.015
Group 2	4.2453*	0.4516	0.000	3.172	5.319
Plts	Group 3	Group 1	-219.892*	35.206	0.000	-303.59	-136.19
Group 2	-52.393	39.294	0.380	-145.81	41.03
MCV	Group 3	Group 1	18.663*	1.938	0.000	14.06	23.27
Group 2	-0.293	2.163	0.990	-5.44	4.85
Retic	Group 3	Group 1	-0.1116	0.1960	0.837	-0.577	0.354
Group 2	0.7780*	0.2187	0.002	0.258	1.298
S. iron	Group 3	Group 1	72.841*	2.713	0.000	66.39	79.29
Group 2	68.720*	3.029	0.000	61.52	75.92
TIBC	Group 3	Group 1	-69.389*	10.633	0.000	-94.67	-44.11
Group 2	109.675*	11.835	0.000	81.53	137.82
Duration of SA	Group 3	Group 1	-5.245*	1.342	0.000	-8.44	-2.06
Group 2	-5.967*	1.497	0.000	-9.53	-2.41
ESR	Group 3	Group 1	-10.730	5.095	0.094	-22.84	1.38
Group 2	-73.260*	5.687	0.000	-86.78	-59.74
CRP	Group 3	Group 1	-0.1976	0.9559	0.977	-2.470	2.075
Group 2	-21.5813*	1.0669	0.000	-24.118	-19.045

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) Group

Mean difference (I-J)

Standard error

Sig.

95% confidence interval

Lower bound

Upper 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.

WBCs

Group 3

Group 1

1.050

0.690

0.285

-0.59

2.69

Group 2

-1.230

0.770

0.251

-3.06

0.60

Group 3

Group 1

5.0528*

0.4046

0.000

4.091

6.015

Group 2

4.2453*

0.4516

0.000

3.172

5.319

Plts

Group 3

Group 1

-219.892*

35.206

0.000

-303.59

-136.19

Group 2

-52.393

39.294

0.380

-145.81

41.03

MCV

Group 3

Group 1

18.663*

1.938

0.000

14.06

23.27

Group 2

-0.293

2.163

0.990

-5.44

4.85

Retic

Group 3

Group 1

-0.1116

0.1960

0.837

-0.577

0.354

Group 2

0.7780*

0.2187

0.002

0.258

1.298

S. iron

Group 3

Group 1

72.841*

2.713

0.000

66.39

79.29

Group 2

68.720*

3.029

0.000

61.52

75.92

TIBC

Group 3

Group 1

-69.389*

10.633

0.000

-94.67

-44.11

Group 2

109.675*

11.835

0.000

81.53

137.82

Duration of SA

Group 3

Group 1

-5.245*

1.342

0.000

-8.44

-2.06

Group 2

-5.967*

1.497

0.000

-9.53

-2.41

ESR

Group 3

Group 1

-10.730

5.095

0.094

-22.84

1.38

Group 2

-73.260*

5.687

0.000

-86.78

-59.74

CRP

Group 3

Group 1

-0.1976

0.9559

0.977

-2.470

2.075

Group 2

-21.5813*

1.0669

0.000

-24.118

-19.045

**Table 4.** Degree and Treatment Modalities of SAs in the Study Patients (total n = 83)
Variable	Group 1 ( n = 53)	Group 2 (n = 30)	P value
Degree of anemia
Non-anemic	0 (0%)	0 (0%)	0.000**
Mild	0 (0%)	2 (6.7%)
Moderate	28 (52.8%)	24 (80%)
Severe	25 (47.2%)	4 (13.3%)
Treatment			0.000**
No treatment	0 (0%)	9 (30%)
Parenteral iron	11 (20.8%)	0 (0%)
Oral iron	40 (75.5%)	8 (26.7%)
Blood transfusion	2 (3.8%)	5 (16.7%)
Oral iron + erythropoietin	0 (0%)	8 (26.7%)

Table 4. Degree and Treatment Modalities of SAs in the Study Patients (total n = 83)

Variable

Group 1 ( n = 53)

Group 2 (n = 30)

P value

Degree of anemia

Non-anemic

0 (0%)

0.000**

Mild

0 (0%)

2 (6.7%)

Moderate

28 (52.8%)

24 (80%)

Severe

25 (47.2%)

4 (13.3%)

Treatment

0.000**

No treatment

0 (0%)

9 (30%)

Parenteral iron

11 (20.8%)

0 (0%)

Oral iron

40 (75.5%)

8 (26.7%)

Blood transfusion

2 (3.8%)

5 (16.7%)

Oral iron + erythropoietin

0 (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 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)
Variable	No splenomegaly, 48 (90.6%)	Splenomegaly, 5 (9.4%)	P value
P value was significant at 0.05 level.
Gender			0.060
Male	21 (43.7%)	4 (80%)
Female	27 (56.3%)	1 (20%)
Residence			0.595
Urban	15 (31.2%)	1 (20%)
Rural	33 (68.8%)	4 (80%)
Nutritional history
Drinking tea			0.405
Excessive	32 (66.7%)	5 (100%)
Mild	16 (33.3%)	0 (0%)
Malnutrition			0.000**
Not present	41 (85.4%)	0 (0%)
Documented	7 (14.6%)	5 (100%)
Signs
Angular cheilitis			0.060
Present	20 (41.7%)	4 (80%)
Absent	28 (58.3%)	1 (20%)
Koilonychias			0.000**
Present	11 (22.9%)	5 (100%)
Absent	37 (77.1%)	0 (0%)
Liver			0.000**
Impalpable	53 (100%)	5 (100%)
Hepatomegaly	0 (0%)	0 (0%)
Degree of anemia			0.000**
Mild	0 (0%)	0 (0%)
Moderate	28 (58.3%)	0 (0%)
Severe	20 (41.7%)	5 (100%)

Table 6. Factors Associated With Splenomegaly in Patients With IDA (Total no = 53)

Variable

No splenomegaly, 48 (90.6%)

Splenomegaly, 5 (9.4%)

P value

P value was significant at 0.05 level.

Gender

0.060

Male

21 (43.7%)

4 (80%)

Female

27 (56.3%)

1 (20%)

Residence

0.595

Urban

15 (31.2%)

1 (20%)

Rural

33 (68.8%)

4 (80%)

Nutritional history

Drinking tea

0.405

Excessive

32 (66.7%)

5 (100%)

Mild

16 (33.3%)

0 (0%)

Malnutrition

0.000**

Not present

41 (85.4%)

0 (0%)

Documented

7 (14.6%)

5 (100%)

Signs

Angular cheilitis

0.060

Present

20 (41.7%)

4 (80%)

Absent

28 (58.3%)

1 (20%)

Koilonychias

0.000**

Present

11 (22.9%)

5 (100%)

Absent

37 (77.1%)

0 (0%)

Liver

0.000**

Impalpable

53 (100%)

5 (100%)

Hepatomegaly

0 (0%)

Degree of anemia

0.000**

Mild

0 (0%)

Moderate

28 (58.3%)

0 (0%)

Severe

20 (41.7%)

5 (100%)