Causes of splenomegaly in children
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Splenomegaly in infants and young children can touch the spleen when touched. However, if the clinical, laboratory, and medical history are normal, most cases of splenomegaly are idiopathic. But in some cases, children with splenomegaly can be due to infection, congestion, primary splenomegaly,...
1. What is an enlarged spleen?
The spleen is a small organ in the human body. The spleen is located just below the upper left rib cage. In addition to being a member of the hematologic system, the spleen is also a part of the body's immune system. This immune system is responsible for creating antibodies against bacteria, viruses as well as parasites when they enter the human body.
The normal spleen will be about 7cm wide, 3-4cm thick, about 12cm long, weighing about 170g for adults and 20g for babies. The spleen is usually covered by ribs 9-11. Therefore, if the spleen is normal, it will not be palpable below the costal margin, in case it is palpable, it shows that the spleen has enlarged to 2-3 times its normal size.
The spleen is often enlarged when the human body is infected with bacteria, parasites or due to some diseases in the liver, blood... Pathological enlargement of the spleen is often accompanied by signs of an enlarged liver.
In the case of children with splenomegaly, the spleen can be palpable in preterm infants, about 15-30% in term infants, 10% in children and 5% in normal adolescents.
2. Causes of splenomegaly in young children
If the spleen is enlarged in infants and young children, the spleen can be touched when touched. However, if the clinical, laboratory, and medical history are normal, most cases of splenomegaly are idiopathic. But in some cases, splenomegaly in children can be caused by some of the following:
Infections that cause splenomegaly in young children:
Germs: Germs that can cause acute systemic infections or infections Chronic infection, subacute endocarditis, abscess, typhoid, tuberculosis, Tularemia cause splenomegaly in children. Spleen infections in children caused by viruses: Some viruses cause splenomegaly in young children such as EBV, CMV or due to hepatitis A, hepatitis B, hepatitis C. Some bacteria such as spirochetes cause syphilis, Lyme, Leptospirose can lead to splenic infections causing splenomegaly in children. Rickettsial infections: Causes Rocky Mountain fever, Q fever, or typhus. Protozoa infections: Malaria, Toxocara catis, Leishmaniasis, Toxoplasma, Toxocara canis, Schistosomiasis, Trypanosomiasis. Fungal infections: Disseminated Candida, Histoplasmosis or Coccidioidomycosis cause splenic infections in children. Blastomycosis infection. Hematologic diseases causing splenomegaly in young children:
Hemolytic anemias such as Thalassemia, erythrocytic anemia, extramedullary hematopoiesis in osteosarcoma or Myelofibrosis and myelodysplastic disease can cause splenomegaly in children . Leprosy causes splenomegaly in young children:
Non-malignant laxatives: Some diseases such as Langerhans histiocytosis; Niemann-Pick disease; GM-1 Gangliosidosis; storage disease (Gaucher disease, Glycogen type IV); Tangier's disease; Wolman's disease; chylomicronemia types I and IV; Amyloidosis and Mucopolysaccharidoses, Sarcoidosis can also splenomegaly in young children. Malignant leukoplakia: Diseased fish such as Leukemia, Lymphoma (Hodgkin and non-Hodgkin).
Congestion causing splenomegaly in young children:
Congestion in the liver: There are a number of causes that can lead to liver congestion such as cirrhosis, neonatal hepatitis or alpha 1 antitrypsin deficiency.... Wilson's disease or cystic fibrosis, portal vein occlusion, splenic-hepatic vein occlusion. Some immunological diseases such as serum sickness, lupus, Felty syndrome, Sjogren's syndrome, Mastocytosis syndrome, macrophage activation syndrome or immunodeficiency, autoimmune lymphoproliferative syndrome, host disease of transplant rejection ,... can cause congestion leading to splenomegaly in children. Primary splenomegaly causing splenomegaly in children:
Cysts or benign tumors such as Hemangioma, Lymphangioma lead to splenomegaly in children. Hemorrhage in the spleen or torsion of an accessory spleen causes splenomegaly.
3. Diagnosis of splenomegaly in young children
Diagnosis based on clinical symptoms: Fever may be a symptom suggestive of an infectious cause; Place an umbilical cord catheter to determine if the cause of the neonatal splenomegaly; Other clinical symptoms such as jaundice, abnormal bleeding, bruising; Determine if there is a family history of hemolytic diseases such as hemolytic anemia, thalassemia; Determine the size of the spleen by measuring the palpable portion below the costal margin as well as auscultation above the spleen; Liver and lymph nodes; Heart murmur, markers of subacute endocarditis. Diagnosis based on laboratory tests: Blood tests, reticulocytes may show signs of hematologic malignancy, hemolysis or parasitic infection leading to splenomegaly in young children. Identify Bilan infection by blood culture method, screening test for CMV, EBV, Toxoplasmosis, HIV, malaria, tuberculosis. Determine hemolysis by testing Haptoglobin, Bilirubin, erythrocyte enzymes, erythrocyte endurance as well as Urobilinogen, Coombs test. Tests to evaluate liver function, α1 antitrypsin deficiency, blood copper, ceruloplasmin and liver biopsy. Evaluation of portal venous pressure by Doppler ultrasound of the portal vein and oesophagoscopy for patients. Identify autoimmune diseases: VS, C3, C4, CH50, ANA, RF. Evaluation of laxative disease by myelogram, marrow biopsy as well as quantitative methods of yeast in Gaucher disease, lymph node biopsy. Diagnostic imaging by CT scan, MRI, hepatosplenomegaly with 99mTc-sulfur colloid Spleen biopsy: In case of necessity, if the cause of splenomegaly in young children cannot be found, it is necessary to biopsy the spleen by Gram stain, culture, immunohistochemical staining, genetic investigation,... Note, if the spleen is mildly enlarged, determine if there is a viral infection and monitor it for 4-8 weeks. If symptoms worsen, admission to the intensive care unit is required. At the same time, it is necessary to determine according to the hematology chart first to see if it is due to hemolytic anemia or extramedullary hematopoiesis, then to determine the inflammation, portal hypertension and finally systemic disease. system, cancer.
However, the indications for testing to determine splenomegaly in children above need to be guided by the clinic, it is not necessary to do all of those tests. If the patient is healthy and the spleen is only mildly enlarged, then basic blood tests should be performed. In case of normal liver and kidney function, there is no need to do more tests but only need to monitor for a few more weeks or months.
Newborns and young children are generally susceptible to respiratory diseases, respiratory infections and gastrointestinal infections if they are introduced to solid foods early or are not properly stored and prepared. To protect children's health, parents should do well to exclusively breastfeed their babies for the first 6 months (if possible) and vaccinate on schedule. As soon as the child has symptoms such as anorexia, fatigue, fussiness and especially splenomegaly, it is necessary to take the child to the hospital to be consulted by a specialist for monitoring and treatment. The pediatric department at Vinmec International General Hospital is the address for receiving and examining diseases that infants and young children are susceptible to: viral fever, bacterial fever, otitis media, pneumonia in children. With a system of facilities, modern medical equipment, sterile space, minimizing the impact as well as the risk of disease spread, Vinmec will bring satisfaction to customers. and is highly appreciated by industry experts with:
Gathering a team of leading pediatricians: including leading experts with high professional qualifications (professors, associate professors, doctors, Master's degree), experienced, worked at major hospitals such as Bach Mai, 108.. The doctors are all well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. Advanced techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in pediatrics more effective: neurosurgery - skull, stem cell transplant blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to play comfortably and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.