physical findings depend on the associated anomalies. Patients with sickle cell disease, especially children may have enlarged spleen. Physical exam features typically include Cyanosis, Cold extremities, Stiff neck, Breathlessness, Pan-systolic murmur, Pre-cordial bulge, Ejection systolic murmur, Right sided apex beat, Abdominal tenderness.

Physical examination of patients with asplenia is:

• During the physical examination, the spleen is usually not palpable except in individuals with thin abdominal musculature, hence lack of a palpable spleen does not confirm asplenia.^[1]
• Patients with sickle cell disease, especially children in their earlier years, may have enlarged nonfunctional spleen.^[2]
• In the case of visceral heterotaxy, a right-sided liver may be mistaken for splenic enlargement.
• Other physical findings depend on the associated anomalies.
• In isolated congenital asplenia, for diagnosis, there are no other physical clues and overwhelming infection may be the first sign of the disease.^[3]
• In patient with sepis physical exam was notable for lethargy, irritable, dry mucous membrane.^[4]

• Patients with asplenia usually appear normal. The following variations can be seen in Asplenia infected by invasive bacterial infection. The following signs can be noticed in patients with asplenia infected by invasive bacterial infection.^[4]
• Fever
• Tachycardia with regular pulse
• Tachypnea
• Hypotention

• Cyanosis may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness.^[2]
• Cold extremities in sepsis. ^[3]

• Neck examination of patients with asplenia is usually normal. In Right-sided isomerism or Heterotaxy syndromes with complex cardiac anomalies, dysphagia may be present.^[5]
• Stiff neck in fulminant pneumococcal meningitis.^[3]

• Respiratory distress may be present in congenital asplenia with visceral heterotaxy with bilateral right-sidedness. ^[2]

Cardiovascular examination of patients with asplenia is usually normal. In Right-sided isomerism or Heterotaxy syndromes with complex cardiac anomalies, it revealed:^[5]

• Pre-cordial bulge
• Right sided apex beat
• Right sided cardiac dullness
• Pan-systolic murmur in right 3–5 intercostal space
• Ejection systolic murmur in right second intercostals space

• Abdominal examination of patients with [asplenia] with sepsis is usually:^[4]
• Diffuse Abdominal tenderness

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