Symptoms

[justgotpaid]

I have palmar erythema, enlarged spleen, and low blood counts, WBC's and platelets.  I have had about 10 liver funtion tests over last 2 years, all normal, and normal ultrasounds, CT scans, and liver/spleen scan except for enlarged spleen.  I have read that palmar erythema can be a presentation of leukemia, does anyone have experience with this?  I had my galbladder removed and the surgeon said my liver was fine, and my gastrointerologist says liver is good as well.  I am just wondering because I cannot get a diagnosis for my enlarged spleen, so was thinking mabie some kind of indolent lymphoma or chronic leukemia.  My low counts and red hands did not present until about 6 months ago, and my spleen has been enlarged for about 2 1/5 years.  So it seems like they are caused by the enlarged spleen.  

[Dennis MD]

Hi.
Sarcoidosis is a chronic, multisystem disorder.   The cause of which is unknown.  The lung is the most commonly involved organ, but other organs like the skin, liver, eye, lymph nodes can also be involved.  Since sarcoidosis can occur anywhere in the body, this can be confused with other systemic diseases.
Pancytopenia (low hemoglobin count, low whit blood cell count, low platelet count) can be a manifestation of sarcoidosis since the marrow is involved in 15 to 20% of patients.  Splenomegaly occurs in about 5 to 10% of cases.  The skin is involved in about 25% of cases and can present with erythema, plaques, or nodules.
Biopsy can help aid in the diagnosis.  
I think a rheumatologist is more knowledgeable in this disease condition.

[justgotpaid]

?? any ideas??

[justgotpaid]

I just noticed that I have small white bumps on my tear ducts and my lips.  Probably 100 on my lips, hard white bumps.  Also my right eye has been bothering me for months being very dry.  I did a google search and found that u can have sarcoidosis in your tear ducts that can cause dry eyes and u can get them on your lips. Do u think these could be sarcoidosis.  I know it can cause splenomegaly and can affect almost any tissue in your body and is sometimes hard to diagnose.  Would an hematologist know how to tests for sarcoidosis?

[justgotpaid]

I have read some medical journals stating that sometimes splenectomy is the only way to diagnose splenomegaly when all other tests have been exhausted.  Here is a study I found on the subject, http://archsurg.ama-assn.org/cgi/content/full/137/1/64.  It states that in 18 cases of idopathic splenomegaly with associated cytopenias, that a diagnosis was obtained by splenectomy in all 18 cases, as well as the cytopenias were resolved by splenectomy.  This is why I believe that if after a bone marrow biopsy I get no answers, I will beg for a splenectomy.  What is your feeling on this study?

[Dennis MD]

Hi.
A bone marrow aspiration biopsy can help in the diagnosis.  This can provide information on the different cell lines, precursors, its morphology and characteristics.  I would suggest you seek the opinion of the second hematologist before undergoing splenectomy.  There are indications for undergoing such procedure, with its associated risks and benefits.  

[justgotpaid]

I have left upper quadrant pain, fatigue, and itching on my face and neck.  I have been tested for hiv, hep a,b, and c, cmv, and many other things, nothing found.  I am willing to test for anything as I feel crummy for over 2 years now.  I have an appointment on april 17 with my second hematologist.  I have also had 2 gastroenterologist tell me they can find no reason for enlarged spleen.  So u say I need to ask for bone marrow biopsy?  I want splenectomy if nothing is found soon as I am tired of left upper quad pain and fatigue.  Also the soles of my feet burn sometimes horrible, this started about the time that my counts dropped.  I heard that thrombocytopenia can cause this.

[Dennis MD]

Hi.
What are your symptoms?
Splenomegaly can be caused by a variety of disorders, ranging from infections to hematologic disorders including lymphomas and leukemias.  The pancytopenia (low hemoglobin count, low white blood cell count, low platelet count) can be a result of your enlarged spleen.
I would suggest you seek consult with a hematologist for further evaluation and management.  A bone marrow aspiration biopsy may be needed in order to rule out the possibility of hematologic disorders.
Good luck.