🩸 Splenomegaly · Infection · Hemolysis · Portal Hypertension · Leukemia · Storage Disease

Schwartz Clinical Handbook — Chapter 73 · Infectious mononucleosis (EBV) · Hemolytic anemia · Portal hypertension (cirrhosis) · Leukemia · Gaucher · Malaria

Select fever, hepatomegaly, lymphadenopathy, pallor, jaundice, easy bruising, and travel history → differentiate infectious (EBV, CMV, malaria, TB), hemolytic (spherocytosis, sickle cell), portal hypertension (cirrhosis, thrombosis), infiltrative (leukemia, lymphoma, Gaucher), and congestive (CHF) splenomegaly.
⚠️ Red flags: splenic rupture risk in mononucleosis → avoid contact sports for 4‑6 weeks. Massive splenomegaly + pancytopenia → leukemia.

📋 Step 1 — Associated systemic & lab clues
📌 Diagnostic impressions
📖 Schwartz Ch 73

Select fever, hepatomegaly, lymphadenopathy, pallor, jaundice, petechiae, bruising, travel history, and labs (CBC, smear, EBV) → differentiate infectious (EBV, CMV, malaria, typhoid), hemolytic (spherocytosis, sickle cell, thalassemia), portal hypertension (cirrhosis, splenic vein thrombosis), infiltrative (leukemia, lymphoma, Gaucher, Niemann‑Pick), and congestive splenomegaly (CHF, constrictive pericarditis).

✔️ EBV: fever, pharyngitis, lymphadenopathy, atypical lymphocytosis.
✔️ Hemolytic: jaundice, reticulocytosis, spherocytes (HS) or sickle cells.
✔️ Portal hypertension: ascites, varices, thrombocytopenia, splenomegaly.
✔️ Leukemia: pancytopenia, blasts, bone pain, hepatosplenomegaly.
✔️ Gaucher: hepatosplenomegaly, bone pain, cytopenias, glucocerebrosidase deficiency.
📘 Schwartz pearls (Chapter 73)
• Palpable spleen tip may be normal in children (up to 30% of term infants).
• Splenectomy for hereditary spherocytosis (if severe anemia) — vaccinate against encapsulated organisms.
• Mononucleosis: avoid contact sports for 4‑6 weeks (splenic rupture risk).
• Malaria: thick/thin smear, travel history.
• Gaucher disease: enzyme replacement therapy (imiglucerase).