Dawaa Reference

Clinical reference

Injury to the spleen or blood-forming organs

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 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 against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

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

SourceStatPearls "Splenic Trauma" - disease-level clinical article

Presentation findings are traced to the source above.

1

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line
Adult dose and duration

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

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose 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.

Cautions
  • 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.