A 3-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-hour history of pain and swelling in his hands. He has had similar episodes in the past. The boy attends day care, but his parents are unsure about any sick contacts. His family history is significant for an older brother who died of pneumococcal sepsis at age 5. The patient appears distressed. His temperature is 38.1°C (100.5°F). Physical examination shows pallor. The dorsum of his hands and fingers are swollen, warm, and tender to palpation. Which of the following is most likely abnormal in this patient?

Question

A 3-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-hour history of pain and swelling in his hands. He has had similar episodes in the past. The boy attends day care, but his parents are unsure about any sick contacts.  His family history is significant for an older brother who died of pneumococcal sepsis at age 5.  The patient appears distressed. His temperature is 38.1°C (100.5°F). Physical examination shows pallor. The dorsum of his hands and fingers are swollen, warm, and tender to palpation. Which of the following is most likely abnormal in this patient?

Quizplus · Accepted Answer

Eductional Objective: Dactylitis (painful swelling of the hands and feet) is a common presentation of sickle cell disease (SCD) in young children.  It is one of many vasoocclusive manifestations of SCD.  Sickling episodes result in hemolysis, which leads to increased indirect bilirubin and lactate dehydrogenase and decreased levels of haptoglobin.

A 3-Year-Old Boy Who Recently Emigrated from Ghana Is Brought