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:
Hemoglobin electrophoresis:
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
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?
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
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