"Add it up"

17 year old with sickle cell anemia, ADHD and Asthma admitted to intensive care for acute chest syndrome and asthma exacerbation. His social history is concerning for compliance and also not having a stable family.

Medication at home:
Impiramine
Albuterol prn

　

CBC:

Detail	Value w/Units	Normal Range
WBC	24.6 K/CMM	4.5-13.5
RBC	2.53 M/CMM	4.20-5.40
Hgb	7.6 g/dL	11.5-15.5
Hct	20.4 %	34.5-46.5
MCV	80.7 fL	75.0-95.0
MCH	30.1 pg	27.0-31.0
MCHC	37.2 g/dL	32.0-36.0
RDW	23.9 %	11.5-14.5
Platelet	353 K/CMM	133-450
MPV	9.0 fL	7.4-10.4

　

Hemoglobin electrophoresis:

Detail	Value w/Units	Normal Range
Hgb S %	84.8 %	0.0-0.0
Hgb A %	4.5 %	95.8-97.8
Hgb A2 %	3.2 %	2.2-3.2
Hgb F %	7.5 %	0.0-1.0
Hgb C %	0.0 %	0.0-0.0

　

　

　

What is the appropriate intervention?

A. Start antibiotics for high WBC
B. Add penicillin prophylaxis
C. Obtain Bone Marrow biopsy
D. Start hydroxyurea
E. None of the above
　
Reference:

http://pediatrics.aappublications.org/content/122/6/1332.short
　

　

Asthmonia

Chest X ray of child with status asthmatics

 

 



source : reference below

 

 

 

 

Name the organism commonly involved and an appropriate test.

 

 

 

 Does the length of hospitalization, ICU stay, days on oxygen, continuous albuterol aerosol requirements change with antimicrobial? (see reference)

 

 

Simkania negevensis- What is its relationship with the above pathogen?

 

References:

 

1. Hanhan et al

2.Simkania

 

 



Anemia : Greek- "anaimía" ; want of blood

10 month infant who is on formula feeds has CBC as below:

Detail	Value w/Units	Normal Range
WBC	12.1   K/CMM	5.5-18.0
RBC	4.99   M/CMM	4.00-5.40
Hgb	11.5   g/dL	10.5-13.5
Hct	33.6   %	31.5-40.5
MCV	67.3   fL	80.0-94.0
MCH	23.1   pg	27.0-31.0
MCHC	34.3   g/dL	32.0-36.0
RDW	13.8   %	11.5-14.5
Platelet	368   K/CMM	133-450
MPV	7.8   fL	7.4-10.4

Hemoglobin Electrophoresis

Detail	Value w/Units
Hgb S %	0.0 %
Hgb A %	64.2 %
Hgb A2 %	4.0 %
Hgb F %	1.3 %
Hgb C %	30.5 %

What is the diagnosis?

Did  the Mentzer index help you?

Was RDW a tie breaker?


Answer:

Normal values

Interpretation


 

Famous names 1

What is the diagnosis named after this physician?
He described from his first patient who was miserable for 12years and end up amputating the leg. The bone showed new bone layers and center of lesion filled with dark colored pus.

 Reference: http://hkoa.org/hkjos/2005-2/079-86%20Great%20names.pdf
 

"Rash"ionale - 2

How do you differentiate urticarial rash from Erythema multiforme?

What is the role of corticosteroid treatment?





Name a bacterial cause.



Arch Dis Child 2011;96:i34-i37 doi:10.1136/adc.2011.214734