was this an early indication of thal ?

Hi
When Hassan was 2 1/2 month old we were vaccationing in India. Everything was ok for the 1st two weeks, but as soon as he turned three months I noticed he was passing stools more frequently. In just a couple of days his stools had turned from yellow to greenish brown. The doc prescribed anti-biotics for 5 days, but after 3 days he started to get a temp also. The doc told us to continue with the same medicine. He had had anti-biotics for 10 days when I returned to Saudi.The same day I took him to a paed as his stools by then had increased in frequency to 14-16 times a day and the colour was bright green. A stool test was taken, the doc said he had dysentry and gave more anti-biotics. Although the frequency reduced to 6-8 times the colour was still the same . We had to stop all medication for 4 days in order to carry out a stool culture. Since he was not on medicines I started him on home remedies( boiled and cooled china grass, camomile tea ). The report came all clear and by then he was passing stools around 4times a day. The doc just said it was probably food contamination. Now when I recall all this I wonder if it was the spleen malfunctioning? Was this due to excess hemolysis. In that one month he had had 5 courses of anti- biotics. After that the only visits to the doc was for vaccination. He was 13 months old when he was diagnosed with thal. To date I still wonder how he held on for so long.
Regards
MAHA

Hi Maha,

Hyperspleenism doesn't start until the spleen is enlarged due to iron overload from multiple transfusion. So you can rule that out.

It can be some infection that he got from food like the doctors suspected.

It is most likely that Hassan did have some type of intestinal illness at that time, which caused the severe diarrhea. There are many water borne illnesses in India and children are very susceptible. It may have been bacterial, viral or even a protozoa or parasite. The symptoms indicate an infectious state. Although splenomegaly can occur in thal infants, that would be an unlikely cause of the symptoms Hassan had. Splenomegaly and hypersplenism are both related to the excess destruction of red blood cells that takes place in thalassemia and are not related to iron overload. For definitive article about the spleen, see http://www.emedicine.com/ped/topic2139.htm

The most common mechanism of splenomegaly in children...can be categorized as excessive antigenic stimulation (ie, infection), disorders of immunoregulation (ie, autoimmune disorders), or excessive destruction of abnormal blood cells (ie, hemolysis).

Splenic siderosis is related to iron overload and as Sajid said, this can only happen after some time with iron overload. In splenic siderosis, the spleen can become inflamed and enlarged and in some cases may need to be removed.

Thanks Sajid and Andy,
Hassan was born in Saudi and here as a routine they take a cbc of all newborns. Since we were not notified about anything out of the ordinary I presume that his hb then was within the normal range.I have read that children start showing symptoms usually after 3 months. Recently I heard of a case where a two month old was diagnosed as thal major with a hb of 2.5gm/dl.Again rupalisaraswat`s baby was diagnosed at the same age with a hb of 4.5. I have noticed with my daughter that whenever she is on anti-biotics her hb falls between 8-10. Since she is not thal her hb builds up on its own once she recovers from infections. Hassan was on anti-biotics for one whole month and his hb must have fallen considerably and since he is a thal major over the months it could only have fallen more. Even then at 13 months he was 5.7. Now the rate at which his hb drops is faster even with folic acid, wheat grass etc...
regards
maha