Sickle cell anemia Diagnostic AnalysisA 10-year-old black boy experienced sudden abdominal, chest, a
Sickle cell anemia Diagnostic AnalysisA 10-year-old black boy experienced sudden abdominal, chest, and diffuse joint pain while playing ice hockey. Both his parents had a family history of sickle cell disease. The results of physical examination were negative except for conjunctival pallor.The patient’s physician suspected that the child had sickle cell anemia. The CBC indicated that he had a normochromic, normocytic anemia. The increased reticulocyte count and erythroplasia seen on bone marrow aspiration indicated that his marrow was attempting to compensate for the anemia. His decreased serum haptoglobin level indicated that hemolysis was occurring. A negative direct Coombs test eliminated an autoimmune cause of the hemolysis. The negative G6PD screen eliminated that deficiency, which is common in the black population. The peripheral blood smear, sickle cell test, and Hgb electrophoresis confirmed the diagnosis of sickle cell anemia.The boy was treated for the sickle cell crisis and released from the hospital. He continued to experience many sickle cell crises and frequently required transfusion of O+ blood. He died at the age of 18 from pneumonia. ResultsComplete blood count (CBC) Red blood cell (RBC) count3.8 million/mm3 (normal: 3.8-5.5 million/mm3)Hemoglobin (Hgb) concentration9.4 g/dL (normal: 11-16 g/dL)Hematocrit (Hct), p. 24828% (normal: 31%-43%)Mean corpuscular volume (MCV)83 mm3 (normal: 80-95 mm3)Mean corpuscular hemoglobin (MCH)28 pg (normal: 27-31 pg)Mean corpuscular hemoglobin concentration (MCHC)34 g/dL (normal: 32-36 g/dL)White blood cell (WBC) and differential counts Total WBC6500/mm3 (normal: 5000-10,000/mm3)Neutrophils60% (normal: 55%-70%)Lymphocytes29% (normal: 20%-40%)Monocytes8% (normal: 2%-8%)Eosinophils2% (normal: 1%-4%)Basophils1% (normal: 0.5%-1%)Peripheral blood smearSickled forms of RBC (normal: normocytic, normochromic RBC)Reticulocyte count4% (normal: 0.5%-2%)Serum haptoglobin level74 mg/dL (normal: 100-50 mg/dL)Bone marrow aspirationErythroid hyperplasia M:E ratio 2:1 (normal: 3:1)Glucose-6-phosphate dehydrogenase (G6PD)Negative (screening test)Hgb electrophoresisHgb F20% (normal: <1%)Hgb A23% (normal: approximately 2%)Hgb S77% (normal: 0)Hgb A10 (normal: 95%-98%)Sickle cell test, p. 415Positive (normal: negative)Coombs test, directNegative (normal: negative)Blood typeO+ Critical Thinking Questions1. Explain the relationship, if any, between the patient's physical activity and the onset of his symptoms.2. Why was the reticulocyte count increased? Health Science Science Nursing ART 266 Share QuestionEmailCopy link Comments (0)
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