A 2-year-old child with sickle cell disease had an upper respiratory tract infection, which was followed by shortness of breath and pallor. On examination, the child looked pale an... A 2-year-old child with sickle cell disease had an upper respiratory tract infection, which was followed by shortness of breath and pallor. On examination, the child looked pale and sick and had splenomegaly. Blood pressure is 90/60 mmHg, heart rate is 110/min, respiratory rate is 25/min, and temperature is 38.6° C. Lab results include: Hb 34 g/L, WBC 3.1 x 109/L, Lymphocytes 52%, Neutrophils 58%, Platelets 166 x 109/L, Reticulocyte 0.1%, ESR 25 mm/h. Which of the following is the best immediate management? A. Splenectomy B. Fluids and analgesia C. Intravenous antibiotics D. Packed red cell transfusion
Understand the Problem
The question describes a 2-year-old child with sickle cell disease presenting with symptoms suggestive of acute anemia and a possible infection. The lab results show low hemoglobin and reticulocytes, indicating a possible aplastic crisis. The question asks for the best immediate management strategy, and we need to choose from the options based on the child's presentation and lab findings.
Answer
Packed red cell transfusion.
The best immediate management is a packed red cell transfusion due to the patient's very low hemoglobin level (34 g/L) and symptoms of severe anemia (shortness of breath, pallor, and signs of splenic sequestration).
Answer for screen readers
The best immediate management is a packed red cell transfusion due to the patient's very low hemoglobin level (34 g/L) and symptoms of severe anemia (shortness of breath, pallor, and signs of splenic sequestration).
More Information
The child's presentation is consistent with splenic sequestration crisis, a life-threatening complication of sickle cell disease. The key findings are a sudden drop in hemoglobin, splenomegaly, and signs of hypovolemic shock. Rapid correction of the anemia with packed red cell transfusion is crucial. While infection may be a concern, the immediate threat is hypovolemic shock from the rapid splenic pooling of red cells.
Tips
A common mistake is to prioritize antibiotics first due to the fever and upper respiratory infection. However, the more immediate life-threatening issue is the severe anemia and splenic sequestration.
Sources
- Splenic Sequestration (for Parents) | Nemours KidsHealth - kidshealth.org
- Pediatric Splenomegaly Clinical Presentation - Medscape Reference - emedicine.medscape.com
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