A 10-year-old African- American boy presents to the University of Cebu Medical
Center complaining of generalized fatigue and mild yellow tinge to his sclera for the
past 4 months. He has no family history of anemia. Liver function tests reveal total
bilirubin of 1.4 mg/dL and direct bilirubin of 0.3 mg/dL. While interviewing with
patient he has severe abdominal pain. CBC reveals hemoglobin of 9.0 g/dL (normal:
12-15 g/dL), hematocrit of 27% (normal 35-42%), and a normal MCV.A peripheral
blood smear reveals sickled RBCs and Howell- Jolly Bodies.
Splenomegaly
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Splenomegaly is defined as enlargement of the spleen measured by weight or
size.

The major functions of the spleen include clearance of senescent and abnormal
erythrocytes and their remnants, opsonized platelets and white blood cells and
removal of microorganisms and antigens. The spleen also serves as a secondary
lymphoid organ and is the site for maturation and storage of T and B
lymphocytes, playing an important role in the synthesis of immunoglobulin G
(IgG) by mature B-lymphocytes upon interaction with the T-lymphocytes.

Splenomegaly may be a transient condition due to acute illness or may be due to
serious underlying acute or chronic pathology.
Chapman, J., Bansal, P., Goyal, A., & Azevedo, A. M. (2017). Splenomegaly.


Elevated levels may indicate liver damage or disease. Higher than normal levels
of direct bilirubin in your blood may indicate your liver isn't clearing bilirubin
properly. Elevated levels of indirect bilirubin may indicate other problems.
In the bloodstream, unconjugated bilirubin binds to albumin to facilitate its
transport to the liver. Once in the liver, glucuronic acid is added to unconjugated
bilirubin by the enzyme glucuronyl transferase. This forms conjugated bilirubin,
which is soluble.
- Bilirubin metabolism - unconjugated - jaundice. TeachMePhysiology. (2022, May 10).
Retrieved September 22, 2022, from
https://teachmephysiology.com/gastrointestinal-system/liver/bilirubin-metabolism/
Chapman, J., Bansal, P., Goyal, A., & Azevedo, A. M. (2017). Splenomegaly.

Splenomegaly is a rare condition, with an estimated prevalence of approximately
2% of the total United States population. In adults, there has been no reported
predominance in prevalence based on ethnicity, gender, or age. In Asia and
Africa, tropical splenomegaly is very common. In older people, the capsule of the
spleen is thin, thus the risk of rupture is higher.

Patients may have an abnormally palpable spleen with or without exam findings
of contributing underlying illness. Patients with splenomegaly due to acute
infection may have exam findings consistent with infectious mononucleosis,
endocarditis, or malaria. Exam findings of petechiae, abnormal mucosal bleeding,
or pallor may accompany hematologic diseases. Jaundice, hepatomegaly, ascites,
or spider angiomata may be present in patients with liver disease. Patients with
rheumatologic diseases may present with joint tenderness, swelling, rash, or an
abnormal lung exam.
Splenomegaly is the enlargement of the spleen. The fact that his liver function tests
reveal that he has abnormal levels of direct and total bilirubin suggests that the liver
isnt clearing the bilirubin properly. We all know that the spleen and liver are
connected with each other, the spleen contains highly elaborate tissue structures and
is anatomically linked to the liver via the portal vein system. His liver isn't working
correctly, which might be the reason of his splenomegaly. The spleen, in addition to
its other activities, accumulates bilirubin, therefore abnormal amounts of bilirubin
may induce enlargement or splenomegaly. The patient’s severe stomach pain may
also be a symptom of the enlarged spleen.