Pediatric splenomegaly

　　The causes of pediatric splenomegaly should first be analyzed from the medical history. Factors such as infection by microorganisms or parasites, congenital hemolytic diseases or metabolic diseases, and other blood diseases or tumor-related diseases should be considered. In addition, splenomegaly is often associated with regional epidemic diseases (such as malaria) and racial genetic diseases (such as thalassemia common in Guangdong and Guangxi), and should also be investigated. Severe splenomegaly is more common in parasitic diseases, bacterial or viral infections, anemia due to malnutrition and infection, congenital metabolic diseases, and Banti's syndrome. Cases with both liver and spleen enlargement are more common in neonates and infants with infections, nutritional anemia, anemia due to malnutrition and infection, hemolytic anemia, congenital metabolic diseases, leukemia, malignant lymphoma, Langerhans cell histiocytosis, and amyloidosis.

　　In addition to its clinical manifestations, pediatric splenomegaly can also cause other diseases. When the disease is complicated with hypersplenism, hemolytic anemia, leukopenia, and other manifestations may occur. Other complications vary depending on the underlying disease.

　　Under normal circumstances, the spleen should not be palpable. Palpation of the spleen below the costal margin in the supine or lateral position indicates that its volume exceeds the normal by a factor of 1. Children have thin abdominal walls and are more easily palpable in the supine position. The normal spleen of a newborn can be palpated 1 to 2 cm below the costal margin. After the first year, the spleen should not be palpable below the costal margin. When palpation cannot determine the size of the spleen, percussion can be used to check for the expansion of the dullness of the spleen. The normal spleen dullness is between the 9th and 11th ribs along the left axillary midline, with a thickness of 4 to 7 cm, and does not exceed the anterior axillary line in front.

　　The main preventive measures for enlarged spleen in children are to pay attention to lifestyle and daily living behavior. Early detection and early treatment, actively treating the primary disease, play an important role in the prevention of enlarged spleen in children.

　　Chemical tests for enlarged spleen in children are mainly aimed at pathogenic examinations. The main examination methods include the following:

　　1. Blood Tests

　　A decrease in the total number of white blood cells often suggests typhoid fever, malaria, kala-azar, non-leukemic leukemia, histoplasmosis, and other conditions. Splenomegaly, with examination of peripheral blood or bone marrow neutrophils, often shows mucopolysaccharide granules, which is typical of mucopolysaccharidosis.

　　2. Hematological Examinations Related to Hemolysis

　　Firstly, determine whether there is hemolysis, and then determine the cause of hemolysis.

　　3. Bone Marrow Examination

　　If the bone marrow smear shows a large number of abnormal immature cells, tissue cells, and lymphosarcoma cells, it is helpful for the diagnosis of leukemia, malignant tissue cell hyperplasia, malignant lymphoma, and other diseases. The presence of plasmodium and Lederer bodies in the bone marrow smear can confirm malaria and kala-azar.

　　4. Liver Function Tests

　　Liver function tests can help determine whether splenomegaly is related to liver disease.

　　Children with enlarged spleen should avoid eating hard,刺激性, fried, spiky, cold, hot, and coarse fiber foods to prevent digestive tract bleeding due to improper diet. Patients should eat light, soft, easily digestible, and nutritious foods. For patients with splenomegaly and hypersplenism, as the enlarged spleen can destroy and isolate blood cells, it can easily lead to a decrease in red blood cells, white blood cells, and platelets. A decrease in red blood cells can lead to anemia, so it is important to eat more foods that tonify Qi and blood in the diet.

　　In most cases, splenomegaly is a local manifestation of systemic diseases. Therefore, treatment should be based on the treatment of the primary disease, with etiological treatment as the main approach. Actively treat the primary disease. Infectious splenomegaly is mainly treated with anti-infection. Leukemia and splenic tumors are mainly treated with anti-tumor chemotherapy. Connective tissue diseases should be treated with hormone therapy and other methods.