Splenomegaly: Clinical Profile, and Spectrum of Etiologies among Yemeni Children. A Two-Years Study in Al Kuwait Hospital, Sana’a-Yemen
Abdulrahman Alhadi*, Majedah Abdulrahman Radman Ali, Mohammed Abduh Ali Aqlan and Ali Ahmed Al-Zaazaai
Background: The spleen is the largest lymphoid tissue with a unique structure that provides an environment for direct contact between blood and immune system. It is vulnerable for enlargement (splenomegaly) beyond normal limits. Splenomegaly is an important sign in pediatrics. Many pathological processes may affect the spleen in children. In most cases it is the result of a systemic disease. Identification of etiology is mandatory for proper management of splenomegaly in children.
Objective: To determine clinical profile, and spectrum of etiologies of splenomegaly among children attending to Al-Kuwait University Hospital in Sana’a-Yemen.
Methods and Settings: It was a retrospective descriptive study collected data of children with splenomegaly over a period of two years (from January 2020 to December 2021). A questionnaire was used to capture data which included demographic data of child (age, gender, resident area, father’s job, family income), data related to characteristics of splenomegaly (degree of splenomegaly, associated hepatomegaly, associated lymphadenopathy, associated anemia, and associated hypersplenism), data related to clinical manifestations, and data related to etiology of splenomegaly.
Results: The study has included 200 children presented with splenomegaly. Number of males was slightly higher than females (53.5% vs 46.5%). The age ranged between 1 years and 15 years with most of the cases (43.5%) in the age group between 6 and 10 years. Most of cases (60%) were coming from rural areas, and most of them (74%) presented with moderately enlarged spleen. An associated hepatomegaly, lymphadenopathy, anemia, hypersplenism were observed in rate of 58.5%, 23%, 79%, and 16% respectively. Results of this study revealed that the most frequent clinical manifestations were fever, pallor, weakness, and abdominal distention in rates of 86.5%, 78%, 60%, and 48% respectively. Followed by jaundice, weight loss, and abdominal pain in rates of 33.5%, 27.5%, and 24% respectively. Other less common symptoms were dyspnea, edema, and bleeding in rates of 22.5%, 18%, and 13.5% respectively. Regarding etiological diagnosis, the most frequent etiologies observed in this study were hematological (27% caused by hemolytic anemias, 9% caused by lymphomas, and 2% caused by leukemias), infective (malaria represented 19%, visceral leishmania represented 6%, enteric fever represented 5%, and septicemia represented 4%), storage disease (glycogen storage disease in 3.5%, and mucopolysaccharidosis in 2.5%), congestive blood flow (portal hypertension in 2.5%, and congestive heart failure in 1.5%), and connective tissue disease represented 3.5%. Unknown diagnosis was documented for 10% of cases. No significant association was found between etiology and gender or age.
Conclusions: Splenomegaly is an important sign in pediatrics. The underlying etiologies observed in this study were hematologic (38%), infectious (34%), storage disease (6%), congestive (4%), connective tissue disease (3.5%), miscellaneous (4.5%), and unknown etiology (10%). Most cases seen in the age group under 10 years, and most of cases presented with moderate degree of splenomegaly. A greater degree of suspicion in these cases and proper laboratory workup and early referral to specialized centers is mandatory and can improve the outcome significantly.
