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Posted On : 21 Sep 2025

A 4-year-old boy came with progressive distention of the abdomen and fever. He has pallor, massive splenomegaly up to the umbilicus, and mild hepatomegaly. Hb 4.4 tlc 3400 platelet 40000, gbp-microcytic hypochromic anemia. PS for mp negative. How should I approach this case? No lymphadenopathy.

Expert Answer :

Answer Discussion :

M

Mohamed Aided

0

massive splenomegaly + pancytopenia. Differential: visceral leishmaniasis, chronic malaria/tropical splenomegaly, acute leukemia, Gaucher’s disease.

3 Days ago

A

Ad Bark

0

Huge splenomegaly pancytopenia, i am thinking about sequestration crisis.. parvovirus infection .. need more detailed history

3 Days ago

P

Patience Atuhaire

0

possible tropical splenomegaly syndrome, rule out lymphoma

4 Days ago

H

hizbullah khan

0

Get his peripheral smear ..
R/O infective etiology (leishmania, Brucellosis )
AIHAs..
Look for Malignancy (leukemia, lymphoma)
Metabolic work for Gaucher's disease for isolated massive splenomegaly (not urgent)

4 Days ago

H

Hazrat bilal Khan

0

r/o
leishminiasis
brucellosis
tropical splenomegaly
HIV Screen
and lastly HLH..

Basic point is the patient is from india/south east asia where we consider infection at top....
so go for Retic count
BMBiopsy ,even splenic biopsy more straightforward approach

5 Days ago

Answer 1

This child had hypersplenism. Reticulocyte count. Hb HPLC is advised to rule out thalassemia intermedia. Serum ferritin to rule out coexisting iron deficiency anemia. DCT will also rule out AIHA. Also, working up for portal hypertension may be fruitful. Bone marrow aspirate is unlikely to be helpful.

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