Splenomegal in children?

Question

a 3 Y girl, with splenomegaly, IgA less than normal, WBC normal but 56% lymphocyte, what are diagosises?

Answer 1

About 10% of children have palpable spleens. This means that the tip of the spleen can be felt just below the level of the ribs on the left side of the abdomen. If the spleen is easily felt and fills more of the abdomen, then it is not something to ignore.

The spleen can be thought of as a big lymph node. It goes up and down in size depending on whether or not an infection is being fought. If enlarged, it shouldn't be tender or enlarged beyond the point where it starts to crowd the abdomen.

Immunoglobulins, or Ig's, are antibodies to things your immune system has determined aren't you and need to be disposed of. IgA's are the immunoglobulins that are secreted into areas your body considers "outside." That means it is the primary defense in fighting infections in your throat, nose, etc. If you  have a "less than normal" amount of IgA, it may mean you are fighting off a virus and the IgA is being used up, or you may be one of the unlucky people who have a genetic abnormality that makes it impossible to make enough IgA. If this is the case, you will be prone to catching colds and getting infections because without enough IgA, you are an easy target. The other immunoglobulins can't do the job.

In conclusion, having no IgA is never normal, but having a low level may just be a sign the body is fighting an infection, so the test needs to be repeated to be significant.

A normal number of white blood cells with a slightly abnormal distribution into certain types of cells can signify, infection as well as other illnesses. When only lymphocytes are elevated (as in this case) it indicates a low grade viral infection. Since the CBC didn't reveal any abnormal white blood cells, just a slightly elevated percentage of lymphocytes, this is most likely just a viral infection and not dangerous.

Before going on to more invasive tests, I would want to know if there were any symptoms of viral infection, like runny nose, cough, vomiting, diarrhea, etc. If none existed, then the next thing I would want is for a qualified pathologist to review the CBC slides. If any immature or abnormal cells are there, the child needs to be worked-up more aggressively. If the slides indicate a viral infection, I'd reexamine the child a week later, then based on these findings, proceed.

Putting it all together, "splenomegaly" in a 3 year-old may just indicate the patient is fighting an infection, as would a change in the IgA levels and CBC. It's always nice to have a better history, but without it, I'd say the child should be reexamined and retested in a week or two. Most viral infections have run their course by then. If the tests are much the same and the spleen is getting larger, then you need to consider non-infectious causes for the symptoms.

Answer 2

idk