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To the Editor.—
In "Splenomegaly: An Algorhythmic Approach to Diagnosis" (1981;246:2858), Edward R. Eichner, MD, and Charles L. Whitfield, MD, recommend in evaluating the condition of the patient with acute or subacute febrile illness and splenomegaly first to obtain three to six blood cultures to rule out subacute bacterial endocarditis (SBE). If the culture results are negative, then they recommend proceeding with a peripheral smear to rule out infectious mononucleosis. In my opinion, these steps should be reversed. A WBC count with peripheral smear is much less expensive than multiple blood cultures, and infectious mononucleosis is much more common than subacute bacterial endocarditis. If, indeed, the authors have found using blood cultures to rule out SBE more cost-effective than first doing WBC counts and peripheral smears to rule out mononucleosis, they must have quite an interesting patient population. This would definitely not be optimal laboratory use in my practice.
Schwarz RL. Evaluation of Splenomegaly. JAMA. 1982;247(15):2096. doi:10.1001/jama.1982.03320400016011