Question

Ralp is a 13-year-old boy Black- American with sickle cell anemia. He has been attending a day camp this summer. He was playing flag footbal in 90 dgree wheather. All of a sudden he complain of severe knee pain bilateraly. His Mom took him to his Dr., who had him directly admitted to the hospital for a sickle cell crisis. Ralph was diagnosed with sickle cell anemia as a newborn with a routine screening. His vaccination are up to date and he recieves a flu vaccine yearly. He has had multiple hospitiozations for sickle cell crisis. On admission, he stated his pain was a 9 on a 1 - 10 pain scale. He is alert and oriented. Both of his knees are red, swollen, and warm to touch. His mucous membranes are slightly pale and slightly dry. Lung sounds are clear bilat., heart tones are normal but slightly tacy at 100. It is 3 pm and he says he only voided once to day. He denies priapism.

1. What is the relationship of Ralph's symptoms today and how it relates to his sickle cell anemia?

2. Why do you think he went into a crisis today? What could he have done to prevent this?

3. What is the sequalae for a child that has had many crisis episodes?

4. What treatments do you expect will be done?

5. Look up the normal value for hemoglobin and hematocrit for a healthy 13-yeasr-old boy, then look up the normal values for a 13 year-old boy with sickle cell anemia. Ralph's labs to day are: Hgb - 9.8 and Hct - .28. Are his values normal for him?

Answer 1

1.Ans-sickel Cell anemia- it is inherited disease which the red blood cellscould not supply enough oxygen to the body. It leads red blood cell  shaped into "C" like sickle So, it can't pass through blood vessel easily and get stuck in small vessel and make blocked which cause insufficient oxygen supply to the body.

In above situation, Ralph had the symptoms of knee pain in both sides, redness, swollen which is caused due to sickle cells got stuck in  blood vessels and blocked and cause pain crisis.when the sickle cells clump together and the blocked the blood vessels in join knee and cause pain.

2)Ans:He went to this pain crisis because of he was playing in the overheating time in summer which can cause dehydration to him.

​​​​​​His parents should have proper knowledge about their child condition and educate the child that should not play like football etc in overheating weather. It causes dehydration and which is very related to pain crisis.

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He may have been prepared for his condition that should have  lots of water and fluids in summer season.

3) Ans:The consequences for the child that have many crises episodes are the proper education to both parents and child.

-should be very careful while playing.

-should avoid exposure to overheating and summer sunlight.

-should have knowledge about drinking lots of water and intake more fluids helps in the crisis management.

4)Ans:The treatment can be given -

​​​​​​ Anti inflammatory can be given for the pain caused by swollen and redness.

-iv trnsfusion to prevent dehydration and promote mor fluid balance in the body.

-hydroxyurea prevents abnormal red blood cells from forming and helps in reducing the pain crisis.

​​​​​5)Ans:normal value of a child's hb level in normal childrenin age of 13yrs are 12.7-17.7gm/dl.

And normal value of a child with sickle cell anemia are range of 6-11gm/dl.

So,Ralph's value is 9.8 is in normal range as he has sickle cell anemia.

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