mononucleosis When splenomegaly occurs without lymphadenopathy, however, attention is drawn to hemolytic disorders such as hereditary spherocytosis and autoimmune hemolytic anemia or hemoglobinopathies (e.g., sickling disorders or thalassemia major) Scleral icterus may also be present in these disorders of shortened red cell survival The finding of an unusually large and firm spleen in the absence of increasing scleral icterus suggests that red cells are being sequestered (e.g., splenic sequestration crisis of SCD, hypersplenism) The skin in a patient with pallor should be examined for evidence of underlying disorders The presence of hemangiomas might suggest microangiopathic anemia If increased bruising or bleeding accompanies pallor, multiple blood elements are probably affected The circulation time of platelets is short in comparison with that of red cells Therefore, clinical findings of thrombocytopenia are often present by the time pallor develops in patients with acquired aplastic anemia, Fanconi anemia, and acute leukemia Clinical evidence of thrombocytopenia may also suggest micorangiopathic anemia as described earlier Sources of internal or external blood loss should be carefully sought Chronic GI bleeding may escape detection until iron-deficiency anemia develops Similarly, small pulmonary hemorrhages associated with idiopathic pulmonary hemosiderosis are often mistaken for other pulmonic processes until several recurrences of iron-deficiency anemia suggest a hidden site of blood loss Bony abnormalities associated with red cell disorders include frontal bossing from compensatory expansion of the bone marrow in hemolytic diseases and upper extremity anomalies found in some patients with Fanconi anemia