A 2-year-old child presents with painful swelling on the dorsal surfaces of the hands, feet, fingers, and toes. Blood pressure 110/70 mmHg, heart rate 100/min, respiratory rate 22/... A 2-year-old child presents with painful swelling on the dorsal surfaces of the hands, feet, fingers, and toes. Blood pressure 110/70 mmHg, heart rate 100/min, respiratory rate 22/min, temperature 38.9° C. Lab results: Hb 77 (normal 112-165 g/L), Reticulocyte 3.9 (normal 0.2-1.2%), blood smear shows elongated and crescent shaped red blood cells. Which of the following is the most appropriate ongoing care? A. Vitamin B12 B. Corticosteroids C. Iron supplement D. Penicillin and immunization
Understand the Problem
The question describes a 2-year-old child presenting with painful swelling and abnormal lab results (low hemoglobin, high reticulocyte count, and sickle-shaped red blood cells). The question asks for the most appropriate ongoing care. This points toward understanding the underlying condition and the best management strategy for it.
Answer
The most appropriate ongoing care is Penicillin and immunization, as the child likely has sickle cell disease.
The most appropriate ongoing care is Penicillin and immunization. The child's presentation suggests sickle cell disease, given the painful swelling of hands and feet (dactylitis), anemia (Hb 77), high reticulocyte count, and crescent-shaped red blood cells. Children with sickle cell disease are at high risk for infections, especially from encapsulated organisms like Streptococcus pneumoniae. Therefore, prophylactic penicillin and ensuring all recommended immunizations are crucial.
Answer for screen readers
The most appropriate ongoing care is Penicillin and immunization. The child's presentation suggests sickle cell disease, given the painful swelling of hands and feet (dactylitis), anemia (Hb 77), high reticulocyte count, and crescent-shaped red blood cells. Children with sickle cell disease are at high risk for infections, especially from encapsulated organisms like Streptococcus pneumoniae. Therefore, prophylactic penicillin and ensuring all recommended immunizations are crucial.
More Information
Children with sickle cell disease are particularly vulnerable to infections due to impaired splenic function. Prophylactic penicillin helps prevent serious infections, and staying up-to-date on vaccinations is also critical for protecting their health.
Tips
It's a common mistake to focus solely on the anemia (low Hb) and consider iron supplementation. However, the combination of symptoms points strongly to sickle cell disease, where the problem isn't iron deficiency but abnormal hemoglobin.
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