# Injury to the spleen or blood-forming organs - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD35 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Splenic Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430920/ - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text INJURY TO THE SPLEEN OR BLOOD-FORMING ORGANS Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class BD35 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Splenic Trauma - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK430920/ Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - The story is usually recent major trauma: a road crash, a high-impact injury, or an assault with a weapon - It can also be quiet: a fall, or abdominal discomfort after contact sport [abdominal pain] - Any blow to the left upper abdomen should raise the question - Kehr sign: pain in the left shoulder made worse by breathing in; some describe left-sided pleuritic pain [chest pain] - Ask about recent infection and about anticoagulants SIGNS - what you find (6) - Findings vary widely and 10% to 20% have no obvious sign; the usual ones are abdominal tenderness and peritonism [abdominal tenderness · guarding] - Look for bruising of the abdominal wall, a haematoma, seatbelt marking or lacerations [bruising · hematoma] - Tenderness, crepitus or deformity of the lower left ribs increases the suspicion [crepitus · visible deformity] - Up to a fifth of adults with lower left rib fractures have a damaged spleen; a child chest wall bends, so serious injury can hide with no fracture - A normal examination does not exclude it when the mechanism or symptoms worry you, and a distracting injury or confusion delays the diagnosis [anxiety · confusion] - Most predictive of intra-abdominal injury after blunt trauma: a seatbelt mark, rebound tenderness, low blood pressure, distension, guarding and a femur fracture, though their absence proves nothing [guarding · hypotension · rebound tenderness] TESTS (9) - FAST scanning quickly finds free fluid in the abdomen and is most useful in the unstable patient - On ultrasound a splenic tear may show as a dark band or black rim around the organ - If the capsule is intact there may be no blood in the peritoneum, and up to 25% of splenic injuries bleed nowhere visible outside the capsule - Free fluid on FAST in an unstable patient calls for immediate surgical assessment - In a stable patient CT is fast and accurate, showing torn splenic tissue, haematoma and blood in the peritoneum - With contrast, CT shows dark areas, a blush or leaking contrast; without intravenous contrast small bleeds are missed however good the scanner - Plain chest films and MRI add little in the acute setting, and CT is not repeated unless the patient deteriorates - Keep watching the vital signs; a haematocrit under 30% suggests intra-abdominal injury but a normal one does not exclude bleeding - The white cell count means little: 12,000 to 20,000 with a left shift is common and also happens with other organ injury IF NOT THIS - what else fits (7) - Liver laceration - Kidney trauma - Retroperitoneal bleeding - Rupture of the diaphragm - Pancreatic injury - Free fluid in the abdomen after trauma should raise the spleen as a source even when the examination says little - A negative FAST does not exclude injury; contrast CT remains the most accurate way to characterise it Source StatPearls "Splenic Trauma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Usually reflects trauma to the spleen or bone marrow-containing bone; this is a surgical/trauma emergency needing urgent transfer, with simple analgesia (avoiding NSAIDs, which increase bleeding risk) as the only primary-care measure. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Usually reflects trauma to the spleen or bone marrow-containing bone; this is a surgical/trauma emergency needing urgent transfer, with simple analgesia (avoiding NSAIDs, which increase bleeding risk) as the only primary-care measure. Caution No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Abdominal pain or left shoulder tip pain after trauma (splenic rupture), signs of shock (tachycardia, hypotension, pallor), expanding bruising, or recent significant trauma. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)