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. Test Result: Hb 77 (Normal Values: 112-165 g/L), Reticulocyte 3.9 (Normal Values: 0.2-1.2%). Blood smear: Several elongated and crescent shaped red blood cells. Which of the following is the most appropriate on-going care? A. Vitamin B12 B. Corticosteroids C. Iron supplement D. Penicillin and immunization Read more

Understand the Problem

The question describes a 2-year-old child presenting with symptoms indicative of a specific condition, further supported by lab results showing abnormal hemoglobin levels, reticulocytosis, and the presence of elongated and crescent-shaped red blood cells on a blood smear. We need to determine the most appropriate ongoing care based on these findings.

More Information

The clinical presentation (swelling of hands and feet, anemia, crescent-shaped red blood cells) strongly suggests sickle cell disease. Children with sickle cell disease are susceptible to infections, particularly from encapsulated organisms like Streptococcus pneumoniae. Penicillin prophylaxis and routine immunizations are crucial in managing sickle cell disease to prevent life-threatening infections.

Tips

A common mistake is to focus solely on the anemia and choose iron supplementation without considering the specific type of anemia and the other clinical findings. Another mistake is to choose corticosteroids without recognizing that there is no indication of an autoimmune condition.

Sources

• Question Sets and Answers - PMC - PubMed Central - pmc.ncbi.nlm.nih.gov
• CLINICAL VIGNETTES - PMC - PubMed Central - pmc.ncbi.nlm.nih.gov
• Tachycardia: Fast Heart Rate | American Heart Association - heart.org