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A six-year-old Caucasian male presents with pallor, jaundice, and recent
history of sore throat. His pediatrician orders a complete blood count that reveals
a hemoglobin of 7.4; he also has an elevated reticulocyte count. Which of the
following is also most likely occurring in this patient?

a) Thrombocytosis

b) Hyponatremia

c) Spherocytes on peripheral smear

d) Malrotation

e) Leukocytosis
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==Answer==
Answer c. Spherocytes on peripheral smear. This child likely has hereditary
spherocytosis (HS), which can present at any age. Acute hemolysis is often
aggravated by a viral infection and presents with the triad of jaundice, anemia,
and splenomegaly. When a peripheral smear shows spherocytes with a loss of
central pallor, this can be quite revealing. If hypersplenism develops,
thrombocytopenia (not thrombocytosis) can follow. Treatment is splenectomy,
but sometimes, these children will also present for cholecystectomy due to the
development of gallstones as a result of hemolysis. Preoperative considerations
for the child with HS include evaluation of degree of anemia, thrombocytopenia,
and splenomegaly. 4
==Notes==
<references />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.
==Keywords==
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