Question: Good Evening Doctor. I wanted to ask a Hematologist about this issue that has me concerned, since July, though I seem to be the only one concerned! I know something is not right but all tests have come back normal, except for the ultra sound. I really think the ultrasound is right because I can feel my spleen. Many doctors have said it is not a big deal if I can feel it, and I have had others that say you should never be able to feel the spleen unless significantly enlarged. Should I be able to feel my spleen just below the coastal margin when I take a deep breath when I am standing, sitting, or barely when laying down? I can, and I do not recall this pressure, ever, before.

Since the CT scan says the size is normal everyone is defaulting to this. My doctor could not feel it when I went in, though she told me it probably is my spleen I am feeling. The ultrasound said it is 14.5cm and is enlarged but not by much. Is there a difference in measurements between a CT scan and the ultrasound? Why would one say normal and one say enlarged? There was only a six day window between scans.

I do not have any symptoms of the serious spleen issues that I can tell (God Willing) (leukemia, or Lymphoma), though my submandibal lympho nodes are always slightly enlarged. Maybe have a FNAC? The ct did not see any enlarged lymph nodes in abdomen or pelvic area. My white blood cell count is normal, and the differential did not flag any abnormal cells (doctor did not see the point in smear or Flow Cytometry). Though the neuts to Lymphs are a 2:1 ratio when I thought they should be a 3:1 ratio.......not sure if that matters. The ultrasound and ct did not show any blockages though I believe a PET scan or MRI would show the blood flow better. As for viruses or bacterial infection I would have though it would have cleared up since it has been 4-6 months with this pressure under my coastal margin.

Again, since the CT scan and blood work show normal the doctors say I am fine, and disregard the ultrasound and the discomfort and concern I have as anxiety from my understanding. I would be fine if I could not feel this under the ribs, but since I can, I have a hard time believing this is normal....because it does not feel normal. Also, I am not a hypochondriac and rarely go to the doctor for anything. Since this started I have been very concerned though.....just wanted to let you know since I am not usually like this. I am really concerned there is more going on based on the way my body is feeling, though the PCP and the Gastroenterologist are not concerned at all. Both said to come back in 6 months for a follow up. Please give me your opinion on this, and whether or not you think any of this is a concern. If it is serious I assume it would be referred to hematologist/Oncologist if needed. I gave everything I could think of in here and apologize for such a large question. I just know I have never been able to feel my spleen before.

Also, I have lost 60 pounds in the last month......it is definitely on purpose though. I am 70in and was weighing 260. I am now 204. I could not drop a pound prior to the scare I got with the ultrasound. When it showed an enlarged spleen and fatty liver I made the mistake of looking it up online. It said cirrhosis is the only time it would enlarge the spleen. The gastro has ruled this out, but it still caused me to watch everything I ate and exercise twice a day for two hours total. Could being obese cause flow issues with the spleen? Can fatty liver cause an enlarged spleen if it is not cirrhosis (portal hypertension)?

Thank you Doctor and I really do appreciate your time!

I have added my bloodwork below:

CBC W/ PLATELET & DIFFERENTIAL
WBC - 8.44
RDW -11.7%
RBC - 5.22
Plt Count - 299
Neut%- 58.2%
Mono%- 7.95%
MCV - 87.1
MCHC - 33.7
MCH - 29.3
Lymph% - 30.1%
Hgb - 15.3
Hct - 45.5%
Eos% - 3.25
Differential Method - Auto
Baso% - .473%
Absolute Neuts - 4.91
Absolute Monos - .671
Absolute Lymphs - 2.54
Absolute Eos - .274
Absolute Basos - .040

COMPREHESIVE METABOLIC PANEL
Triglycerides - 186 (H)
T. Bilirubin - .89
I. Bilirubin - .64 (H)
D. Bilirubin - .25
Sodium - 136
Serum Total Protein - 7.2
Potassium - 4.0
LDL Cholestrol, Calc - 76
HDL Cholestrol - 34 (L)
Glucose - 86
Globulin - 2.6
Creatinine - 1.0
Cholestrol - 147
Chloride - 104
CO2 - 29
Calculated Osmolality - 280 (L)
Calcium - 10
BUN - 11
B/C Ratio - 11 (L)
AST - 19
Anion Gap - 3.0
ALP - 62
A/G ratio - 1.8
Albumin - 4.6
ALT - 21

TIBC- 416
% saturation - 15% (L)
Iron - 61 (seems low for a male but in normal range?)

OTHER TEST DONE FOR THE LIVER:
Pro time - 12.9 sec (H)
INR - 1.1
Ferritin - 131
TSH - 1.58
Hep A/B/C - negative
A-1-Antitrypsin Phenotype - normal
AMA - Normal
Actin Ab. IgG - Normal
Cerulopasmin - 25
ANA screen - negative
AFP Tumor Marker - 2.0 (normal range)
tTG IgA - 1 (normal range)
tTG-IgG Ab -1 (normal Range)
XXXXXXX Fibrosure - XXXXXXX score (0.50) - No fibrosis/Moderate Steatosis - borderline XXXXXXX

I noticed the weight lost said 60 pounds in a month....this is a typo. Since July I have lost 60 pounds. Thank you and sorry.



XXXXXXX

Thank you doctor. Is the PET scan due to concerns over the weight loss and lymph nodes? I only started loosing weight after I changed my diet and started exercising. I have already started putting weight back on.The lymph nodes have been slightly enlarged for years. In your opinion what is the PET scan looking for? I assume you are not concerned I can feel the spleen and that aspect is fine. I appreciate your time and was trying to find out what you are looking for with the PET scan. Lymphoma? Thank you!