 |  sickle cell disease q
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| Author | 18 Posts |
mac007
Forum Junior
Topics: 4
Posts: 38
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an 18 yrs old man with sickle cell disease comes to emergency because of shorthness of breath for 6 hrs. he has had a low grade fever,jt aches & rash for 3 days . he was prev. health & has had vaso occlusive crisis . he takes folic acid regularly & has req.ed no bld transfutions for past 8 yrs. his hematocrit has been stable at 32%. his temp 100.6f ,bp=120/86,pulse= 120/mint.the lungs r clear to auscultation n percusion. there is no liver n splen.he has pain with the movement of jts but there is no evidence of arthiritis .his hematocrit is 21%,lecuocyte count =11500/mm3 platelet=450000/mm3.chest x-ray is normal, which of the foll most appropriate next step in daignosis
a)Hb electrophoresis
b) measurement of bleedind time
c) measurement of reticuocyte count
d) serum hiv abs
e) ct abdomen
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| ARJ
Forum Guru
Topics: 133
Posts: 792
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C) measurement of reticulocyte count. May be parvovirus induced Aplastic Anemia
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| mac007
Forum Junior
Topics: 4
Posts: 38
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u r correct ARJ
can u explain why not HBb electrophoresis ,kaplan says Hb elec is most specific test
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| mani
Forum Guru
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Posts: 1,403
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well patient is already known to have sickle cell dis. What do u want to get out of Hb electrophoresis?
i agree with answer given
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| phuluong2k
Forum Fanatic
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Hb electrophoresis is required for diagnosis of sickle cell disease, this patient is already diagnosed.
Here we need a test for its complication.
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| dr.vasim
Forum Senior
Topics: 4
Posts: 61
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ok. after mesurmnt of reticulocyte n +ve report of parvov. induced Aplastic Anemia the next step will b?
a. starting Hematinics
b. txtin with AB
c. RBC infusion
d. bone aspiration study
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| phuluong2k
Forum Fanatic
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go for d
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| drkpp
Forum Guru
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sorry guys i feel a little left out!!!!!!!!!
if this was aplastic anemia wouldnt there be a decrease on all cell lineages? instead here the no.s are horrendous!!!
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| Dr.D
Forum Senior
Topics: 22
Posts: 191
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Ya with aplastic crisis all cell lines will be low.
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| sprint123
Forum Guru
Topics: 129
Posts: 870
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If all lines are low,then how come that could be the answer for this quetsion???Please explain
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| usmle12
Forum Senior
Topics: 19
Posts: 194
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ITS TREATING WITH ABS AS THERE IS NO NEED TO DO AN INVASIVE PROCEDURE LIKE ASPIRATION JUST TO CONFIRM THAT HE HAS GOT APLASTIC CRISIS
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| r_albayunen
Forum Senior
Topics: 0
Posts: 218
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aplastic anemia induced by parvovirus causes an aplastic anemia (all cell lines) ..
well maybe they want a confirmation with an Hb elec .. i dont see any other test done .. maybe a CT abd to look for any spleen infarction ..
suggestions?
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| sachida
Forum Guru
Topics: 62
Posts: 624
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Patient to me is in sickling crisis and should get pain killer and hydration first.
Again, aplastic anemia does not present in the manner suggested in question. They usually present with infection/bleeding diathesis/severe anemia.
Hb electrophoresis should be done to look at the amount of fetal hemoglobin. Hydroxyurea should be given to increase HbF and decrease HbS. (I learened that in heme clinic observership for last 6 months). I really dont know how retic count will be usefull except to rule OUT aplastic anemica secondary to parvo infection.
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| sachida
Forum Guru
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Posts: 624
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I guess, examiner could be asking us to suspect parvo infection based on the arthralgia (most common symptom in adult parvo infection) and rash. In that case, we should go for retic count
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| Justice
Just signed contract
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(C)
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| allie
Forum Newbie
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hi guys...
i would go with C.....
coz Kaplan says... in sickle cell crisis Hct should not decrease...
and if it does then it is either due to
a)concurrent hemolysis by:
1.G6PD def.
2.splenic sequestration crisis..
b)Parvovirus B19
c)Folate def..
and since pt is takin folate last option is ruled out...
left with the rest if we get retic count which would be elevated in hemolysis..
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| sachida
Forum Guru
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Posts: 624
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does parvovirus induce hemolysis or suppress bone marrow?
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| sachida
Forum Guru
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Posts: 624
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parvovirus targets erythroblasts- progenitor of RBC resulting into aplstic crisis. So with parvovirus infection you will get LOW retic count not high.
and LDH (increase) and heptoglobin (decrease) are far better indicator of hemolysis
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