Splenomegaly in children
Keywords:Hacketts classification, Hepatomegaly, Hemolytic anemia, Splenomegaly
Background: Splenomegaly occurs when the size of the spleen is increased by cells or tissue components or by vascular engorgement. In childhood, it is generally first suspected upon physical examination. The aim of the present study was to find out the prevalence and possible cause of splenomegaly in children admitted in pediatric ward and NICU at tertiary care center.
Methods: In this study, total 124 children of age between 0-12 years with clinically palpable splenomegaly, admitted to the wards were studied during the period of 18 months. A detailed history, thorough clinical and all relevant investigation was done. The enlargement of the spleen was graded as per Hacketts and conventional classification. The prevalence, cause of splenomegaly and outcome of the study was noted.
Results: The prevalence of splenomegaly was 1.46%. Most common grade of splenomegaly was grade III (33%) of Hackett’s classification. The most common presenting symptom was fever (75%) and sign was pallor (97%). Most common cause of splenomegaly was hemolytic anemia (80.64%) among which thalasemia was 50% followed by sickle cell anemia 30.64%. Out of 124 patients, 123 (99.1%) received medical treatment while only one patient (0.9%) underwent surgical treatment. Among medically treated patients 18 (14.5%) were recovered completely while 100 (80.6%) improved and 4 (3.2%) stable and two patients were (1.6%) died.
Conclusions: In patient with grade III, IV, and V of splenomegaly is more likely to have hemolytic anemia as common etiology and hematological investigation should be given more emphasis in a case of splenomegaly.
McIntyre OR, Ebauch FG Jr. Palpable spleens in college freshmen. Ann Intern Med. 1967;66:301.
Eichner ER. Splenic function: normal, too much and too little. Am J Med. 1979;66(2):311-20.
Radhakrishnan N, Sacher RA. Splenomegaly overview. Available at: https://emedicine.medscape.com/article/206208-overview.
Poza AL, Godfrey EM, Bowles KM. Splenomegaly: Investigations, diagnosis and management. Blood Rev. 2009;23:105-11.
Gozman A, Sill RH. Pediatric splenomegaly. Available at: https://emedicine.medscape.com/ article/958739-overview.
Arkles LB, Gill GD, Molan MP. A palpable spleen is not necessarily enlarged or pathological. Med J Aust. 1986;145(1):15-7.
Brown NF, Marks DJ, Smith PJ, Bloom SL. Splenomegaly. Br J Hosp Med. 2011;72(11):166-9.
Odom LF, Tubergen DG. Splenomegaly in children, identifying the cause. Postgrad Med. 1979;65(4):191-3.
Hackett LW. Spleen measurement in malaria. J Malariott. 1944;3:121-33.
Michael G, Williams DM. Hutchinson’s clinical Methods. 23rd ed. London Philadelphia: Elsevier; 2012: 227-228.
Konan TM, Kouame KJ, Konan A, Tanoh AF, Oulai S, Andoh J, et al. Etiology of splenomegaly in children in the tropics. 178 cases reviewed at the university hospital center of Abidjan-Cocody (Ivory Coast)). J Ann Pediatr. 1992;39(2):13641.
Pore SN. Clinicopathological study of splenomegaly in pediatric age group. Int J Recent Trends Sci Tech. 2016;21(1):45-50.
Chandanwale SS. Hematological profile in splenomegaly-a study of 50 cases. IJPBS. 2015;5(2):368-78.
Agarwal D, Mittal A. Hematology-A diagnostic tool in cases of splenomegaly. Int J Biomed Adv Res. 2016;7(9):413-7.
Dabadghao VS, Diwan AG, Raskar AM. A clinico-haematological profile of splenomegaly. Bombay Hosp J. 2012;54(1):10-18.
Singh N, Mishra AK, Shukla MM, Chand SK. Forest malaria in Chindwara, Madhya Pradesh, Central India: a case study in a tribal community. Am J Trop Med Hyg. 2003;68(5):602-7.