Q. I am anemic, my ESR is raised, and I feel my spleen is enlarged in chest X-ray. Kindly help me.

Answered by
Dr. Padmesh Jain
and medically reviewed by Dr. Sushrutha Muralidharan
This is a premium question & answer published on Jul 22, 2021

Hi doctor,

I have no symptoms, and I am healthy. I had a chest X-ray last week to check my ribs due to a fall that I had. Last year I had a chest X-ray and then a chest CT and was told that I have a calcified granuloma in one of my lungs from an old infection and nothing to worry about. I also had a breast reduction last year. I just want to make sure everything else looks good on this X-ray. I worry a lot about health anxiety. Please tell me that my liver and spleen look okay. I am attaching my reports. Kindly give your opinion.



Welcome to

Please do not worry so much that you turn hypochondriac. Worrying will bring in illness that you do not have. Just eat healthily, be happy, exercise, have good close friends & family, stay away from alcohol and smoking.

The X-ray you have provided (attachments removed to protect the patient's identity) does not show any significant abnormalities in the region of the liver and spleen.

However, if you are very much concerned and want to ascertain the healthiness of the liver, spleen, and other abdominal organs, I would suggest you get an ultrasonography of the whole abdomen done. In that, ask the sonographer for liver size, echotexture, fatty liver, cysts, etc., and also the gall bladder if there are any stones or polyps within.

For functionality assessment, get a baseline blood investigations done comprising complete blood count, liver function tests, lipid profile, blood sugars (fasting, post-lunch, HbA1c (hemoglobin A1c)), and creatinine.

I will help and comment more if you can share images of your CT (computed tomography) scan.

I hope this was helpful.

Hi doctor,

Thank you.

A nurse friend of mine said that it looks like the spleen might be enlarged. You do not see any evidence of any enlargement, right? Do lymph nodes look normal and everything else on the X-ray?

I am not that concerned, it is just that I am a hypochondriac. I had blood work done a few days ago, and everything was normal except possible iron deficiency anemia (which I have known about for years), and my ESR was 41, which I am very worried about. However, I was on my menstrual cycle when I had my blood drawn. I take birth control, have adenomyosis of the uterus and ovarian cysts, and I am obese. I also had severe anxiety episodes in the past few weeks. For which I have seen a psychiatrist and will be taking Zoloft. I am not sure if any of that could contribute to the ESR, but what do you think?

Kindly give your opinion.



Welcome back to

Firstly, the spleen and lymph node cannot be adequately assessed on a chest X-ray. Like I told you before, ultrasonography is a modality to assess the same (CT scan will be even better). Lymph Nodes can be seen on X-ray when they are calcified. So I will not be able to comment on the status of the spleen or lymph nodes on X-ray.

Secondly, if you have an enlarged spleen, it may be connected to long-standing anemia, as you mentioned. Raised ESR (erythrocyte sedimentation rate) also may be related to it. We also need to rule out tuberculosis in cases of raised ESR, for which a TB-PCR (tuberculosis-polymerase chain reaction) test and Mantoux test are advised.

Obesity is an independent risk factor for metabolic syndrome, hypertension, diabetes mellitus, and adverse cardiovascular events. So please try to reduce weight by exercise and diet. That will also help in curbing symptoms of adenomyosis and improve your reproductive health and overall well-being.

I hope this was helpful. Please follow-up with the reports.

Hi doctor,

Thank you.

Does iron deficiency anemia cause an enlarged spleen?

My spleen was palpated by my doctor a few days ago, and he said it does not feel enlarged. I do not have any symptoms like feeling full after eating fast. I am probably worrying for no reason. My spleen was enlarged four years ago due to something temporary, but my hematologist monitored it, and it returned to normal. Again, would factors like menstruation, birth control, adenomyosis, or obesity raise the ESR? I also sprained my ankle on twenty-eight two months ago.

Kindly give your opinion.



Welcome back to

Yes, few cases of iron deficiency anemia may cause an enlarged spleen. I would like to know if the cause of your anemia has been confirmed as iron deficiency and nothing else (such as sickle disease, thalassemia trait, etc.). A few blood tests are required to confirm the diagnosis of iron deficiency anemia, such as serum ferritin, total iron-binding capacity (TIBC), and transferrin saturation. If the cause of your anemia is something else, then taking iron capsules may harm rather than cure.

Temporary enlargement of the spleen is very common in many illnesses. So do not worry. Birth control pills and adenomyosis may raise the ESR a bit but not up to 41. Similarly, obesity and hypercholesterolemia may alter the ESR to some extent.

However, severe anemia will cause more rise of ESR, which may be the thing in your case. Please share your hematological reports to give me a better insight into your issues. Once your anemia gets better, the ESR will also improve.

Sprained ankle usually resolves in a couple of weeks with adequate rest and anti-inflammatory medications. I suggest you do the blood investigations mentioned above.

I hope this was helpful. Kindly follow up with reports.

Dr. Jain,

Here’s the latest bloodwork. My CRP isn’t back yet.

As for the ferritin, it hasn’t been tested in 4 years, since my spleen was temporarily enlarged. I do remember it being low though. I’m going to attach that bloodwork as well. Please note the dates on the screenshots.

I was supposed to take iron but I discontinued it because of side effects. I’m going to start an iron supplement that’s more gentle on the stomach if it’s okay to.

I’m just really worried about the ESR. Based off of my bloodwork, do you think iron deficiency anemia’s the main culprit why it’s raised?

Thank you.

# Greetings Dear Jessie,

Apologies for little delay in this reply.

I went through your blood work-up screenshot reports you sent.

I'm happy that they are good. your sugar levels as denoted by glycosylated Hemoglobin ( HbA1c ) of 4.6 is very good indicating good sugar control. Also , Kidney function as suggested by Creatinine ( 0.77) ,eGFR and electrolyte levels is normal. Similarly, Liver function as indicated by normal values of proteins, bilirubin, AST , ALT is good.

However among st your Lipid profile , Triglyceride levels are high which can be managed by dietary modification ( cut down on intake of fats), lifestyle changes ( cardio, aerobics etc). At this stage, I wont recommend medicine (Fenofibrate ) for lowering triglyceride as it is sightly above the upper limit of normal range with can be well managed by diet & exercise.

Now, coming on to your Anemia part. As per your reports dated 7th March 2021, your Hemoglobin level is 13.5 g/dL which is well within the normal range and thus excludes diagnosis of Anemia. However a slightly lower value of Mean Corpuscuar volume (MCV) and Mean Corpuscular Hemoglobin ( MCH) with slight increase in Iron Binding Capacity ( IBC) indicate Mild IRon Deficiency. A higher reticulocyte count indicates that you bone marrow is responding good enough to keep red blood cell levels good in your body.

As far as oral Iron tablets are concerned, you may take "Ferrous / Iron carbonate" preparations as they are shown to have fewer side effects and are better tolerated by patients.

Overall, your reports are good and you seem to be in a good state of health. Don't lose your sleep over isolated finding of raised ESR (which can be just incidental and innocuous ).

i would just suggest you to get following tests done after 8 weeks and follow up :- Serum Lipid profile,
Complete blood count with ESR, Reticulocyte count
Iron studies

Hope this helps. Just be happy, eat healthy, exercise well, sleep sound.
Best regards.
Investigations to be done:

get following tests done after 8 weeks and follow up :-
Serum Lipid profile,
Complete blood count with ESR, Reticulocyte count
Iron studies

Regarding follow up:

get following tests done after 8 weeks and follow up :- Serum Lipid profile,
Complete blood count with ESR, Reticulocyte count
Iron studies

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