|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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