Abdomen short casesPossible cases

Hepatosplenomegaly Ascites Renal lump

You found a massive hepatosplenomagaly (firm spleen). What this could be due to?Transfusion dependant anemiae.g. β thalessmia majoraplastic anemiaGaucher’s Dx, osteopetrosis, pure red cell aplasia, HSWhy β thalessmia major?Because it is common

Do you think this child is adequately transfused? Inadequate transfusion result in

Growth failure Bony deformities Splenomegaly or early splenectomy Pallor is indicative of this episode But still need to know pre-transfusion

Hb level 9.5-10g/dl

Inadequate chelation results in1. Pigmentation 2. Complications

1. Cardiac: auscultate chest for murmurs

2. Hepatic 3. Endocrine-

i. Gonads - Tanner stage

ii. Thyroid- T4iii. DM

But still need to know trend of serum ferritin level: 100-200 normal 1000-1500 adequateAdherent to chelation regime

Why do you say this is spleen?1. Has its shape & notch2. Can not feel the upper border3. Not ballotable4. No band of resonance5. Direction of enlargement towards RIF

Could this be leukemia?1. Ill looking2. Bone tenderness

3. Pallor4. LNE5. Splenomegaly6. FBC→ abnormal cells7. Needs BM biopsy to exclude