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pediatric splenomegaly with HIV B2
Oct 17, 2008

What is your opinion about a splenectomy in a 10 years old boy with perinatal hiv (B2)? He has been through all of hematology tests with negative results. He has had a liver biopsy that was negative. His platelet count has been below 90 for the past 2 years. His platelets started falling after a bout with samonella. His spleen was just barely palpable at that time. His spleen has been enlarged for almost 2 years with no significent increase in the last year. It's is so large now that a CT scan with contrast, shows that it has moved his stomach and small intestines to the right. He was taken off his HARRT for the past 2 months, with no change in the platelet count, his undetectable viral load or his CD4's of 330 (26%. As a precaution he will start new liver friendly meds this week. I have read everything I can find on this procedure and the information gives me an equal amount of pros and cons. I am really afarid of this procedure, but the doctors keep telling me he's a 10 year old very active boy and it would be worse if it ruptures. Thank you for any advice or comfort you can give me.

Response from Dr. Henry

Massive splenomegaly can cause a number of problems including low platelet count. Splenectomy is often effective for treatment of low platelet count. Gamma globulin infusions and/or burst of steroids are sometimes effective and are often tried prior to considering splenectomy. Generally I would continue HIV treatment as well. KH

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