Enlarged liver, spleen and anemia in children: differential diagnosis

"Curiosity is a willing, a proud and eager confession of ignorance"

Following are few causes of enlarged liver and spleen with anemia:

Hepatosplenomegaly (HSM) with Anemia
Etiology	Pointers	Investigation
Chronic Malaria	High fever +- chills/rigor endemic region	Malaria QBC test
Kala-azar	fever jaundice skin discoloration	RK-39 antigen test PCR testing Bone marrow
TORCH	microcephaly cataract, retinitis deafness heart defect	TORCH screen
Leukemia	short history compared to hemolytic anemia Sick child Severe pallor Hx of bleeding manifestations Generalised lymphadenopathy Bone tenderness Proptosis dt chloroma gum hypertrophy Mediastinal syndrome	Peripheral smear
Hemolytic anemia: Thalassemia major Sickle cell anemia G6PD deficiency Hereditary spherocytosis	Consanguinity (Thal and SCA) Hx of blood transfusion  Hx of aplastic crisis or vaso-occlusive crisis No bleeding manifestations Cooliey’s facies Short stature	mild unconjugated hyperbil Peripheral smear:normoblast, microcytic hypochromic, target cells, sickle cells Retic count: increased except aplastic crisis/ thal major dt ineffective erythropoiesis Hb electrophoresis
Osteopetrosis congenita	Consanguinity Sib death (dt anemia or bleeding) Blindness Deafness Dysmorphism: depressed nasal bridge Generalised lymphadenopathy	X-ray long bone: marble bone appearance and  fracture X-ray skull: increased density of basal bones
Letterer-Siwe syndrome	Persistent ear discharge excessive seborrhoeic dermatitis purpuric lesions	X-ray skull: lytic lesions Bone marrow
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