A six year old child is evaluated because of an enlarged abdomen.
Physical examination reveals hepatosplenomegaly and lymphadenopathy.
There is no history of recent infection. The child's temperature is normal. Developmental milestones are normal, and the child is doing well in the first grade. Laboratory data indicates that the child has mild anemia and leukopenia with thrombocytopenia. Following bone marrow biopsy, a splenectomy is performed.