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
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