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A palpable spleen is in the fingertips of the beholder; our algorithm is for documented splenomegaly. Almost 3% of college freshmen may have palpable spleens; how many have splenomegaly is unknown. The authors of that study said the percentage of students with palpable spleens dropped substantially when the examining physicians changed, and they admitted that the ability of certain students to relax and breathe deeply may have made normal spleens easier to palpate. In any case, an algorithm does not have to be followed to the end; the physician can stop at any point that good judgment dictates. Of course, there is a place for simply following up certain patients with asymptomatic splenomegaly and normal CBC counts.
Eichner ER. Diagnosis of Splenomegaly-Reply. JAMA. 1982;247(15):2096. doi:10.1001/jama.1982.03320400016010
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