Question

Spleen is palpable in all haemolytic anemias in a child of 8 years of age, EXCEPT in

• A. Thalassemia
• B. Spherocytosis
• C. Sickle-cell anemia
• D. Haemolysis in malaria

Hint:

Think about autosplenectomy and at what age it typically happens in sickle-cell disease.

Answer 1

The Correct Option is C

Step 1: Recall why the spleen enlarges in hemolytic anemia.
In most chronic hemolytic anemias, the spleen works overtime to remove abnormal red cells and often becomes enlarged and palpable.

Step 2: Check thalassemia.
Thalassemia causes ongoing hemolysis and extramedullary blood formation, so the spleen becomes big and is easily felt.

Step 3: Check spherocytosis.
Hereditary spherocytosis causes fragile, round red cells that get trapped and destroyed in the spleen, so splenomegaly is a hallmark finding here too.

Step 4: Check hemolysis in malaria.
Malaria causes destruction of red cells and reactive spleen enlargement, so the spleen is palpable in most cases.

Step 5: Check sickle-cell anemia.
In sickle-cell disease, repeated infarcts caused by sickled cells blocking small splenic vessels destroy the spleen's tissue over the first few years of life. By around 8 years of age, most children have gone through autosplenectomy, meaning the spleen has shrunk down and scarred so much that it can no longer be felt, despite ongoing hemolysis.

Step 6: Final answer.
So among these choices, the one where the spleen is usually not palpable by 8 years of age is sickle-cell anemia.
\[ \boxed{\text{Sickle-cell anemia}} \]