This is a young male patient who has been diagnosed with “chronic hepatitis B” for 4 years and received antiviral treatment 3 years ago. According to conventional thinking, it is certainly not a good thing for a patient with chronic hepatitis B to have a progressively enlarged spleen. I took the patient’s ultrasound report and read it carefully. The spleen had increased from 15 cm long three years ago to 17.5 cm at present, but I carefully looked at the ultrasound image of the liver: the light point echogenicity was slightly thickened and evenly distributed, the distribution of intrahepatic ducts was normal, the internal diameter of the portal vein was 1.16 cm, and the internal diameter of the splenic vein was 0.6 cm. However, why was the patient’s spleen getting larger despite stable liver function and negative HBVDNA with antiviral therapy? I then reviewed the patient’s liver function report for three years. The patient’s transaminase level was basically normal for three years, but the indirect bilirubin was always elevated. This could be a hereditary abnormality of bilirubin metabolism called “Gilbert’s syndrome”, but it would not cause the enlargement of the spleen. Combining this patient’s long-term indirect bilirubin elevation and progressive spleen enlargement, I considered that the patient might have a chronic hemolysis, and that the cause of this chronic hemolysis might be a blood disorder called “hereditary spherocytosis”. So I had the patient undergo a morphological examination of the red blood cells, which showed that the percentage of small spherical red blood cells was greater than 10% and indeed increased. As a precaution, I sent the patient to the hematology department to further clarify the diagnosis. Hereditary spherocytosis is a type of hemolytic anemia caused by defects in the red blood cell membrane. It can manifest clinically as a marked increase in spherical red blood cells, increased friability to hypotonic saline solutions, and varying degrees of jaundice and splenomegaly. The normal red blood cells in our body are biconcave disc shaped and look like donut cakes. This shape helps the red blood cells to maintain good deformability and also has an increased ability to carry oxygen. Spherical red blood cells lack the ability to deform and are larger in size, so when they pass through the capillaries of the spleen, the red blood cells will “squeeze through” and manifest as hemolysis, and the spleen will gradually enlarge as a result of long-term chronic hemolysis. This hemolysis is usually mild and does not necessarily show anemia, except in acute attacks, so it is often missed clinically. Splenectomy is effective in the treatment of this disease, but is usually only needed in severe hemolysis. ”I don’t know the true face of the mountain, but I am only in the mountain”. The clinical condition of the patient is very variable, and at this time, the doctor needs to have a pair of wise eyes to analyze from different angles so that he or she will not be blinded by the illusion.