eMedicine Specialties > Pediatrics: General Medicine > Hematology

Splenomegaly: Follow-up

Author: Mundeep K Kainth, DO, Resident Physician, Department of Pediatrics, The Children's Hospital at Albany Medical Center
Coauthor(s): Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP, Associate Professor of Pediatric Hematology-Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute; Richard H Sills, MD, Professor of Pediatrics, Upstate Medical University
Contributor Information and Disclosures

Updated: Sep 4, 2008

Follow-up

Further Inpatient Care

  • Further care depends on the specific etiology of the splenomegaly and, rarely, on the splenomegaly itself.
  • The development of hypersplenism with resulting anemia, leukopenia, and/or thrombocytopenia can be severe enough to cause serious problems, although this is not usually the case.

Complications

  • Splenic rupture may occur in acute splenomegaly associated with infectious mononucleosis. The incidence is 1:1000, and it usually occurs in the first 3 weeks of illness.9 Therefore, the American Academy of Pediatrics Council on Sports Medicine and Fitness has recommended that children with acute splenomegaly restrict their participation in sport.27  Disorders associated with chronic splenomegaly do not have the same splenic friability and risk of rupture.28,27  
  • Splenectomy is uncommonly performed in children with splenomegaly. Nevertheless, should it be clinically indicated, the overall risk of postsplenectomy sepsis is approximately 2%, with increased incidence and mortality in young children.10,11
  • Hypersplenism is the occurrence of thrombocytopenia, and occasionally leukopenia and anemia, in the context of significant splenomegaly.12 The thrombocytopenia is usually mild, and, in liver cirrhosis, the underlying mechanism may involve mechanical pooling and cytokine changes.29,13

Prognosis

  • The prognosis depends on the specific etiology of the splenomegaly.

Patient Education

  • Risks of traumatic rupture of a large and/or fragile spleen must be discussed.
  • Other education depends on identifying the specific etiology of the splenomegaly.

Miscellaneous

Medicolegal Pitfalls

  • Recommended restrictions on physical activity for children with acute splenomegaly need to be enforced, even for those with relatively modest splenomegaly, because patients with mononucleosis have friable spleens that may rupture, with catastrophic effect.
  • When patients have chronic splenomegaly, follow the American Academy of Pediatrics guidelines and assess the degree of splenomegaly, its underlying cause, and the involvement of the patient's family and others who provide supervision, before approving the patient's participation in contact or collision sports.
  • If splenectomy is medically indicated, ensure that appropriate immunizations are given prior to the procedure, and the family is appropriately counseled on care of the asplenic child.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Wayne Hioe, MD, to the development and writing of this article.



More on Splenomegaly

Overview: Splenomegaly
Differential Diagnoses & Workup: Splenomegaly
Treatment & Medication: Splenomegaly
Follow-up: Splenomegaly
References
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References

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Further Reading

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Keywords

splenomegaly, splenic enlargement, enlarged spleen, palpable spleen, hypersplenism, splenic enlargement, splenectomy, mononuclear-phagocyte system, MPS, malaria, schistosomiasis, hyperreactive malarial splenomegaly, splenic rupture, noncirrhotic portal fibrosis, sickle cell disease, hepatitis, portal hypertension, abdominal trauma, splenic hematoma, diarrhea, salmonellosis, leukemia, Hodgkin disease, jaundice, sepsis, hypotension, umbilical catheter thrombosis, anemia, leishmaniasis, trypanosomiasis, splenic pseudocyst, cytomegalovirus, human immunodeficiency virus, HIV, hemolytic anemia–associated gallstones, hemolytic anemia, thalassemia, glucose-6-phosphate dehydrogenase deficiency, G6PD deficiency, hereditary pyropoikilocytosis, pyruvate kinase deficiency, hereditary spherocytosis

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Contributor Information and Disclosures

Author

Mundeep K Kainth, DO, Resident Physician, Department of Pediatrics, The Children's Hospital at Albany Medical Center
Mundeep K Kainth, DO is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Coauthor(s)

Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP, Associate Professor of Pediatric Hematology-Oncology, Department of Pediatrics, Albany Medical Center; Faculty, Alden March Bioethics Institute
Vikramjit S Kanwar, MBBS, MBA, MRCP(UK), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and Royal College of Physicians of the United Kingdom
Disclosure: Nothing to disclose.

Richard H Sills, MD, Professor of Pediatrics, Upstate Medical University
Richard H Sills, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Medical Editor

J Martin Johnston, MD, Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Pediatric Hematology/Oncology, Backus Children's Hospital; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital
J Martin Johnston, MD is a member of the following medical societies: American Society of Pediatric Hematology/Oncology and Idaho Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing Editor

James L Harper, MD, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center
James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD, King Fahd Professor of Pediatric Oncology, Department of Oncology, Division of Pediatric Oncology, Johns Hopkins University School of Medicine
Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

 
 
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