Blood & Lymphoreticular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P7_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027ve been assigned to the pediatrics consulting room this month, and it\u0027s turning out to be one of your favorite rotations.\r\n \r\nYou\u0027re humming pleasantly to yourself when the nurse says, \u0022Your next patient is on the way, doc.\u0022\n\n\u0022Thanks!\u0022 you respond, just as a woman enters with a young boy.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P7_F2.jpg"}},{"insert":"\n\n"},{"insert":"\u0022This is my son, Rodney,\u0022 says the lady. \r\n \r\n\u0022He\u0027s just turned four. His feet have been swollen for two days now, and I think it\u0027s getting worse,\u0022 she continues, worriedly.\n\nYou learn that Rodney and his family recently migrated from Burkina Faso.\r\n \r\nWhile there is no history of trauma, he has been having occasional joint pains since the age of two, especially in cold weather. This would resolve with paracetamol.\n\nHis parents first sought medical help around five months ago, when he suffered from jaundice.\r\n \r\nAt the time, his symptoms were attributed to malaria, which was successfully treated at a hospital in his old country.\r\n \r\nHis immunizations are up to date and his siblings have not had similar complaints.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P7_F3.jpg"}},{"insert":"\n\n"},{"insert":"Suspecting sickle cell dactylitis, you order a hemoglobin electrophoresis in addition to a full blood count, blood culture, and X-rays of both feet.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P7_F4.jpg"}},{"insert":"\n\n"},{"insert":"The following day, Rodney and his parents return to discuss his labs. The test results read as follows:\r\n\r\nRBC: 3.85 x 10\u2076\/\u00b5L (3.80-5.20)\r\nWBC: 14.8 x 10\u00b3\/\u00b5L (4.5-14.5)\r\nHemoglobin: 8 g\/dL (10.9-14.9)\r\nHematocrit: 30% (33-44)\r\nMCV: 76 fL (76-96)\r\nMCH: 27 pg (27-32)\r\nPlatelet count: 225 billions\/L (150-450)\n\nHemoglobin electrophoresis:\r\n\r\nHbA 1: 40% (95%-98%)\r\nHbA 2: 2% (1.5%-3.5%)\r\nHbF: 1% (\u003C 2%)\r\nHbC: 0% (0%)\r\nHbS: 57% (0%)\n\nThe X-rays are unremarkable, while culture results are still pending.\r\n\r\nYou confirm your diagnosis from these results, then proceed to counsel the family and prescribe treatment for Rodney.\n"}]}