Question

Spleen is palpable in all haemolytic anemias in a child of 8 years of age, EXCEPT in

• A. Thalassemia
• B. Spherocytosis
• C. Sickle-cell anemia
• D. Haemolysis in malaria

Hint:

Think about autosplenectomy and at what age it typically happens in sickle-cell disease.

Answer 1

The Correct Option is C

Chronic hemolytic anemias usually make the spleen work harder to clear damaged red cells, and this often makes the spleen big enough to feel. The question asks which of four hemolytic conditions is the exception in an 8 year old.

1. Thalassemia: Ongoing red cell destruction and compensatory blood formation in the spleen keep it enlarged and palpable through childhood.
2. Spherocytosis: The abnormally shaped, fragile red cells get trapped and broken down in the spleen, so an enlarged, palpable spleen is a classic finding.
3. Sickle-cell anemia: Sickled cells repeatedly block the small vessels inside the spleen, causing small infarcts from early infancy onward. By about 8 years of age, this process has usually destroyed and shrunk the spleen so much, called autosplenectomy, that it is no longer felt on exam, even though hemolysis continues.
4. Haemolysis in malaria: Red cell destruction from malaria triggers reactive spleen enlargement, so the spleen is usually palpable.

Three of these conditions keep an enlarged, palpable spleen, but sickle-cell anemia is different because repeated infarcts scar the spleen down over time.

Let's summarize:

• Most chronic hemolytic anemias cause splenomegaly from extra workload on the spleen.
• Sickle-cell disease instead damages and shrinks the spleen through repeated infarcts.
• By 8 years, most sickle-cell patients have undergone autosplenectomy, so the spleen is not felt.

So the exception is sickle-cell anemia.