J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website https://www.jocmr.org

Original Article

Volume 15, Number 1, January 2023, pages 38-50

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

Figure 1. The contrast-enhanced CT scan finding of patients with splenic infarction. The arrow indicates splenic infarction. CT: computed tomography.

Figure 2. The changes over time in the number of published case reports on splenic infarction. CVD: cardiovascular disease; Hb: hemoglobin; RBCs: red blood cells.

Figure 3. The summary of present study. APTT: activated partial thromboplastin time; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CRP: C-reactive protein; CT: computed tomography; LDH: lactate dehydrogenase.

**Table 1.** Clinical Characteristics of Patients With Splenic Infarction (n = 18)
The percentage of patients with abdominal pain, fever, and tachycardia is calculated using the number of cases described in the electronic medical record as the denominator. Fever and tachycardia mean body temperature > 38 °C and heart rate > 100 beats/min, respectively.
Sex (male/female)	11/7
Age (years)	78 ± 10
Body height (cm)	159 ± 8
Body weight (kg)	56 ± 13
Body mass index (kg/m²)	21.9 ± 4.2
Abdominal pain (n, %)	5/10, 50%
Maximal body temperature (°C)	38.0 ± 1.0
Fever (n, %)	8/14, 57.1%
Systolic blood pressure (mm Hg)	131 ± 24
Diastolic blood pressure (mm Hg)	68 ± 16
Heart rate (beats/min)	91 ± 20
Tachycardia (n, %)	6/15, 40%
Clinical outcome (death/survival)	6/12

Table 1. Clinical Characteristics of Patients With Splenic Infarction (n = 18)

The percentage of patients with abdominal pain, fever, and tachycardia is calculated using the number of cases described in the electronic medical record as the denominator. Fever and tachycardia mean body temperature > 38 °C and heart rate > 100 beats/min, respectively.

Sex (male/female)

11/7

Age (years)

78 ± 10

Body height (cm)

159 ± 8

Body weight (kg)

56 ± 13

Body mass index (kg/m²)

21.9 ± 4.2

Abdominal pain (n, %)

5/10, 50%

Maximal body temperature (°C)

38.0 ± 1.0

Fever (n, %)

8/14, 57.1%

Systolic blood pressure (mm Hg)

131 ± 24

Diastolic blood pressure (mm Hg)

68 ± 16

Heart rate (beats/min)

91 ± 20

Tachycardia (n, %)

6/15, 40%

Clinical outcome (death/survival)

6/12

**Table 2.** Laboratory Medical Characteristics of Patients With Splenic Infarction (n = 18)
Laboratory examination	n	Values in patients	Normal range
APTT: activated partial thromboplastin time; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CRP: C-reactive protein; CK: creatine kinase; γ-GT: γ-glutamyl transferase; LDH: lactate dehydrogenase; PG: plasma glucose; PT: prothrombin time; RBCs: red blood cells; WBCs: white blood cells.
Blood cells
WBCs (cells/µL)	18	12,500 ± 9,000	3,300 - 8,600
Neutrophils (%)	16	75 ± 22	42 - 74
Lymphocytes (%)	16	12 ± 10	18 - 50
Monocytes (%)	16	6 ± 3	2 - 10
Eosinophils (%)	16	1 ± 1	1 - 5
Basophils (%)	15	0.3 ± 0.4	0 - 1
RBCs (cells × 10⁴/µL)	18	385 ± 100	435 - 555
Hemoglobin (g/dL)	18	10.9 ± 3.1	13.7 - 16.8
Hematocrit (%)	18	33.3 ± 8.2	40.7 - 50.1
Platelets (cells × 10⁴/µL)	18	19 ± 12	15.8 - 34.8
Coagulation fibrinolytic system
PT (international normalized ratio)	13	1.3 ± 0.3	1
APTT (s)	11	37.3 ± 20.8	20 - 40
Fibrinogen (mg/dL)	6	461 ± 265	150 - 400
D-dimer (mg/mL)	7	380.5 ± 800.0	< 1.0
Biochemistry
Albumin (g/dL)	18	3.0 ± 0.8	4.1 - 5.1
AST (U/L)	18	87 ± 107	13 - 30
ALT (U/L)	18	48 ± 48	10 - 42
γ-GT (U/L)	17	127 ± 122	13 - 64
LDH (U/L)	17	412 ± 294	124 - 222
CK (U/L)	14	193 ± 400	59 - 248
BUN (mg/dL)	18	20 ± 7	8 - 20
Creatinine (mg/dL)	18	0.8 ± 0.3	0.65 - 1.07
CRP (mg/dL)	14	7.2 ± 7.4	0.00 - 0.14
PG (mg/dL)	8	142 ± 77	73 - 109

Table 2. Laboratory Medical Characteristics of Patients With Splenic Infarction (n = 18)

Laboratory examination

Values in patients

Normal range

APTT: activated partial thromboplastin time; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CRP: C-reactive protein; CK: creatine kinase; γ-GT: γ-glutamyl transferase; LDH: lactate dehydrogenase; PG: plasma glucose; PT: prothrombin time; RBCs: red blood cells; WBCs: white blood cells.

Blood cells

WBCs (cells/µL)

12,500 ± 9,000

3,300 - 8,600

Neutrophils (%)

75 ± 22

42 - 74

Lymphocytes (%)

12 ± 10

18 - 50

Monocytes (%)

6 ± 3

2 - 10

Eosinophils (%)

1 ± 1

1 - 5

Basophils (%)

0.3 ± 0.4

0 - 1

RBCs (cells × 10⁴/µL)

385 ± 100

435 - 555

Hemoglobin (g/dL)

10.9 ± 3.1

13.7 - 16.8

Hematocrit (%)

33.3 ± 8.2

40.7 - 50.1

Platelets (cells × 10⁴/µL)

19 ± 12

15.8 - 34.8

Coagulation fibrinolytic system

PT (international normalized ratio)

1.3 ± 0.3

APTT (s)

37.3 ± 20.8

20 - 40

Fibrinogen (mg/dL)

461 ± 265

150 - 400

D-dimer (mg/mL)

380.5 ± 800.0

< 1.0

Biochemistry

Albumin (g/dL)

3.0 ± 0.8

4.1 - 5.1

AST (U/L)

87 ± 107

13 - 30

ALT (U/L)

48 ± 48

10 - 42

γ-GT (U/L)

127 ± 122

13 - 64

LDH (U/L)

412 ± 294

124 - 222

CK (U/L)

193 ± 400

59 - 248

BUN (mg/dL)

20 ± 7

8 - 20

Creatinine (mg/dL)

0.8 ± 0.3

0.65 - 1.07

CRP (mg/dL)

7.2 ± 7.4

0.00 - 0.14

PG (mg/dL)

142 ± 77

73 - 109

**Table 3.** Computed Tomographic Findings of Spleen in Patients With Splenic Infarction
Long axis of spleen (cm)	9.3 ± 1.7
Short axis of spleen (cm)	3.8 ± 1.1
Maximal cross-sectional area of spleen (cm²)	36.2 ± 15.4
Volume of spleen (cm³)	299.4 ± 220.4

Table 3. Computed Tomographic Findings of Spleen in Patients With Splenic Infarction

Long axis of spleen (cm)

9.3 ± 1.7

Short axis of spleen (cm)

3.8 ± 1.1

Maximal cross-sectional area of spleen (cm²)

36.2 ± 15.4

Volume of spleen (cm³)

299.4 ± 220.4

**Table 4.** Age, Sex, Comorbidity, Presence of Abdominal Pain, Body Temperature, Heart Rate, Anticoagulant Use, and Clinical Outcome of Patients With Splenic Infarction
Cases	Age	Sex	Comorbidity	Abdominal pain	Maximal body temperature (°C)	Heat rate (beats/min)	History of anticoagulant use	Start of anticoagulant	Outcome
NA: not available.
1	88	Female	Abdominal aortic dissection, Atrial fibrillation	+	35.8	101			Death
2	70	Male	Pancreatic carcinoma	NA	37.7	87			Death
3	79	Male	Septic shock	NA	38.9	126			Death
4	79	Female	Cerebral infarction	+	39.1	72	+		Death
5	91	Female	Liver cirrhosis, heart failure	NA	37.4	85			Death
6	87	Male	Diabetes, dehydration	+	38.5	103		+	Death
7	52	Female	Infective endocarditis, sigmoid colon cancer	-	39.0	120			Survival
8	84	Female	Pyelonephritis	NA	38.7	74			Survival
9	76	Female	Malignant lymphoma	+	38.4	122		+	Survival
10	70	Male	Unknown	NA	NA	NA			Survival
11	80	Male	Pancreatic carcinoma	+	38.6	78			Survival
12	67	Female	Lung cancer	NA	NA	NA			Survival
13	70	Female	Unknown	NA	NA	NA			Survival
14	71	Female	Atrial fibrillation	-	37.4	83	+		Survival
15	80	Female	Colon cancer, renal infarction, protein C deficiency	-	37.8	77		+	Survival
16	88	Female	Atrial fibrillation	-	NA	60	+		Survival
17	85	Male	Diabetic gangrene, colon cancer	NA	38.7	102			Survival
18	87	Male	Atrial fibrillation	-	37.9	75		+	Survival

Table 4. Age, Sex, Comorbidity, Presence of Abdominal Pain, Body Temperature, Heart Rate, Anticoagulant Use, and Clinical Outcome of Patients With Splenic Infarction

Cases

Age

Sex

Comorbidity

Abdominal pain

Maximal body temperature (°C)

Heat rate (beats/min)

History of anticoagulant use

Start of anticoagulant

Outcome

NA: not available.

Female

Abdominal aortic dissection, Atrial fibrillation

35.8

101

Death

Male

Pancreatic carcinoma

37.7

Death

Male

Septic shock

38.9

126

Death

Female

Cerebral infarction

39.1

Death

Female

Liver cirrhosis, heart failure

37.4

Death

Male

Diabetes, dehydration

38.5

103

Death

Female

Infective endocarditis, sigmoid colon cancer

39.0

120

Survival

Female

Pyelonephritis

38.7

Survival

Female

Malignant lymphoma

38.4

122

Survival

Male

Unknown

Survival

Male

Pancreatic carcinoma

38.6

Survival

Female

Lung cancer

Survival

Female

Unknown

Survival

Female

Atrial fibrillation

37.4

Survival

Female

Colon cancer, renal infarction, protein C deficiency

37.8

Survival

Female

Atrial fibrillation

Survival

Male

Diabetic gangrene, colon cancer

38.7

102

Survival

Male

Atrial fibrillation

37.9

Survival

**Table 5.** Clinical Characteristics of Splenic Infarction Patients Who Died or Survived
	Patients who died	Patients who survived	P value
The percentage of patients with abdominal pain, fever, and tachycardia is calculated using the number of cases described in the electronic medical record as the denominator. Fever and tachycardia mean body temperature > 38 °C and heart rate > 100 beats/min, respectively.
Sex (male/female)	3/3	4/8	0.157
Age (years)	82.3 ± 7.1	75.8 ± 10.0	0.198
Body mass index (kg/m²)	19.0 ± 4.0	23.0 ± 3.7	0.2
Maximal body temperature (°C)	37.7 ± 1.1	38.3 ± 0.5	0.245
Fever (n, %)	3/6, 50%	5/8, 62.5%	0.78
Systolic blood pressure (mm Hg)	126 ± 23	135 ± 24	0.497
Diastolic blood pressure (mm Hg)	69 ± 15	67 ± 17	0.859
Heart rate (beats/min)	96 ± 17	88 ± 20	0.487
Tachycardia (n, %)	3/6, 50%	3/9, 33.3%	0.22

Table 5. Clinical Characteristics of Splenic Infarction Patients Who Died or Survived

Patients who died

Patients who survived

P value

Sex (male/female)

3/3

4/8

0.157

Age (years)

82.3 ± 7.1

75.8 ± 10.0

0.198

Body mass index (kg/m²)

19.0 ± 4.0

23.0 ± 3.7

0.2

Maximal body temperature (°C)

37.7 ± 1.1

38.3 ± 0.5

0.245

Fever (n, %)

3/6, 50%

5/8, 62.5%

0.78

Systolic blood pressure (mm Hg)

126 ± 23

135 ± 24

0.497

Diastolic blood pressure (mm Hg)

69 ± 15

67 ± 17

0.859

Heart rate (beats/min)

96 ± 17

88 ± 20

0.487

Tachycardia (n, %)

3/6, 50%

3/9, 33.3%

0.22

**Table 6.** Laboratory Medical Characteristics of Splenic Infarction Patients Who Died or Survived
Laboratory examination	Patients who died	Patients who survived	P value
APTT: activated partial thromboplastin time; ALT: alanine aminotransferase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CRP: C-reactive protein; CK: creatine kinase; γ-GT: γ-glutamyl transferase; LDH: lactate dehydrogenase; PG: plasma glucose; PT: prothrombin time; RBCs: red blood cells; WBCs: white blood cells.
Blood cells
WBCs (cells/µL)	19,633 ± 9,222	8,950 ± 6,561	0.017
Neutrophils (%)	86 ± 5	69 ± 25	0.124
Lymphocytes (%)	6 ± 4	16 ± 10	0.049
Monocytes (%)	6 ± 3	7 ± 3	0.938
Eosinophil (%)	0.5 ± 0.4	1.3 ± 1.3	0.191
Basophils (%)	0.3 ± 0.4	0.3 ± 0.5	1
RBCs (cells × 10⁴/µL)	369 ± 109	393 ± 94	0.656
Hemoglobin (g/dL)	10.2 ± 2.4	11.3 ± 3.4	0.511
Hematocrit (%)	31.7 ± 6.4	34.2 ± 8.9	0.567
Platelets (cells × 10⁴/µL)	15.7 ± 7.0	20.6 ± 12.9	0.425
Coagulation fibrinolytic system
PT (international normalized ratio)	1.5 ± 0.4	1.2 ± 0.2	0.174
APTT (seconds)	58 ± 31	29 ± 5	0.045
Fibrinogen (mg/dL)	55 ± 5	541 ± 214	0.042
D-dimer (mg/mL)	1,127 ± 1,041	8 ± 5	0.098
Biochemistry
Albumin (g/dL)	2.6 ± 0.7	3.2 ± 0.8	0.166
AST (U/L)	176 ± 143	43 ± 36	0.011
ALT (U/L)	84 ± 54	31 ± 31	0.022
γ-GT (U/L)	127 ± 120	127 ± 123	1
LDH (U/L)	628 ± 374	296 ± 137	0.026
CK (U/L)	362 ± 612	98 ± 127	0.271
BUN (mg/dL)	26 ± 7	16 ± 5	0.005
Creatinine (mg/dL)	0.97 ± 0.41	0.79 ± 0.22	0.249
CRP (mg/dL)	6.6 ± 5.7	7.5 ± 8.2	0.848
PG (mg/dL)	121 ± 23	149 ± 87	0.709

Table 6. Laboratory Medical Characteristics of Splenic Infarction Patients Who Died or Survived

Laboratory examination

Patients who died

Patients who survived

P value

Blood cells

WBCs (cells/µL)

19,633 ± 9,222

8,950 ± 6,561

0.017

Neutrophils (%)

86 ± 5

69 ± 25

0.124

Lymphocytes (%)

6 ± 4

16 ± 10

0.049

Monocytes (%)

6 ± 3

7 ± 3

0.938

Eosinophil (%)

0.5 ± 0.4

1.3 ± 1.3

0.191

Basophils (%)

0.3 ± 0.4

0.3 ± 0.5

RBCs (cells × 10⁴/µL)

369 ± 109

393 ± 94

0.656

Hemoglobin (g/dL)

10.2 ± 2.4

11.3 ± 3.4

0.511

Hematocrit (%)

31.7 ± 6.4

34.2 ± 8.9

0.567

Platelets (cells × 10⁴/µL)

15.7 ± 7.0

20.6 ± 12.9

0.425

Coagulation fibrinolytic system

PT (international normalized ratio)

1.5 ± 0.4

1.2 ± 0.2

0.174

APTT (seconds)

58 ± 31

29 ± 5

0.045

Fibrinogen (mg/dL)

55 ± 5

541 ± 214

0.042

D-dimer (mg/mL)

1,127 ± 1,041

8 ± 5

0.098

Biochemistry

Albumin (g/dL)

2.6 ± 0.7

3.2 ± 0.8

0.166

AST (U/L)

176 ± 143

43 ± 36

0.011

ALT (U/L)

84 ± 54

31 ± 31

0.022

γ-GT (U/L)

127 ± 120

127 ± 123

LDH (U/L)

628 ± 374

296 ± 137

0.026

CK (U/L)

362 ± 612

98 ± 127

0.271

BUN (mg/dL)

26 ± 7

16 ± 5

0.005

Creatinine (mg/dL)

0.97 ± 0.41

0.79 ± 0.22

0.249

CRP (mg/dL)

6.6 ± 5.7

7.5 ± 8.2

0.848

PG (mg/dL)

121 ± 23

149 ± 87

0.709

**Table 7.** Computed Tomographic Findings of Spleen in Splenic Infarction Patients Who Died or Survived
Computed tomographic findings	Patients who died	Patients who survived	P value
Long axis of spleen (cm)	9.9 ± 1.7	8.9 ± 1.7	0.283
Short axis of spleen (cm)	4.5 ± 1.1	3.4 ± 0.8	0.039
Maximal cross-sectional area of spleen (cm²)	46.1 ± 17.0	31.3 ± 11.7	0.058
Volume of spleen (cm³)	423.8 ± 282.1	237.4 ± 146.4	0.101

Table 7. Computed Tomographic Findings of Spleen in Splenic Infarction Patients Who Died or Survived

Computed tomographic findings

Patients who died

Patients who survived

P value

Long axis of spleen (cm)

9.9 ± 1.7

8.9 ± 1.7

0.283

Short axis of spleen (cm)

4.5 ± 1.1

3.4 ± 0.8

0.039

Maximal cross-sectional area of spleen (cm²)

46.1 ± 17.0

31.3 ± 11.7

0.058

Volume of spleen (cm³)

423.8 ± 282.1

237.4 ± 146.4

0.101

**Table 8.** The Etiology of Splenic Infarction Found by Literature Search
Causes of splenic infarction	References
COVID-19: coronavirus disease 2019; ANCA: anti-neutrophil cytoplasmic antibody.
Infection
Cytomegalovirus	[6-8]
Epstein-Barr virus	[9-15]
Infective endocarditis	[16-22]
COVID-19	[23-35]
Dengue virus	[36]
Mycoplasma pneumoniae	[37, 38]
Malaria	[39, 40]
Scrub typhus	[41, 42]
Aspergillus pericarditis	[43]
Babesiosis	[44]
Malignancy including neoplasm and myeloproliferative diseases
Polycythemia vera	[45]
Essential thrombocythemia	[46]
Ovarian carcinoma	[47]
Acute T-cell lymphoblastic leukemia	[48]
Angiosarcoma	[49]
B-cell lymphoma	[50, 51]
Abnormal red blood cells and hemoglobin, and coagulation abnormality
Hereditary spherocytosis	[52]
Sickle cell disease	[53-57]
Hemoglobin SE disease	[58]
β-Thalassemia	[59]
Protein C deficiency	[60]
Antiphospholipid syndrome	[61]
Vasculitis
ANCA-associated vasculitis	[62-64]
Eosinophilic granulomatosis with polyangiitis	[65]
Cardiovascular disease, atrial fibrillation
Atrial fibrillation	[66, 67]

Table 8. The Etiology of Splenic Infarction Found by Literature Search

Causes of splenic infarction

References

COVID-19: coronavirus disease 2019; ANCA: anti-neutrophil cytoplasmic antibody.

Infection

Cytomegalovirus

[6-8]

Epstein-Barr virus

[9-15]

Infective endocarditis

[16-22]

COVID-19

[23-35]

Dengue virus

[36]

Mycoplasma pneumoniae

[37, 38]

Malaria

[39, 40]

Scrub typhus

[41, 42]

Aspergillus pericarditis

[43]

Babesiosis

[44]

Malignancy including neoplasm and myeloproliferative diseases

Polycythemia vera

[45]

Essential thrombocythemia

[46]

Ovarian carcinoma

[47]

Acute T-cell lymphoblastic leukemia

[48]

Angiosarcoma

[49]

B-cell lymphoma

[50, 51]

Abnormal red blood cells and hemoglobin, and coagulation abnormality

Hereditary spherocytosis

[52]

Sickle cell disease

[53-57]

Hemoglobin SE disease

[58]

β-Thalassemia

[59]

Protein C deficiency

[60]

Antiphospholipid syndrome

[61]

Vasculitis

ANCA-associated vasculitis

[62-64]

Eosinophilic granulomatosis with polyangiitis

[65]

Cardiovascular disease, atrial fibrillation

Atrial fibrillation

[66, 67]