Diagnosis of the Day – 2



Diagnosis of the Day – 10

IC/CC: A 4 year-old black male presents with swelling of the hands and feet, fever, headache, and a feeling of heaviness in the abdomen.

HPI: The child has recurrent abdominal pain and joint pain (due to ischemia). He has also been wetting his bed. The child’s cousin has been recently diagnosed with a blood disorder.

PE:VS: fever (38.3 C). Pallor of the conjunctiva, skin, and mucous membranes. Hypoxic spots on the retina. Heart has regular rate and rhythm with no murmurs. The lungs are clear. Splenomegaly is present. The skin over the metacarpals and metatarsals is warm to the touch, and the joints are tender.

Labs: Peripheral blood smear (RBC’s put under the microscope) demonstrate abnormally-shaped erythrocytes. Anemia is present.

Questions

1. Dactylitis is the most frequent initial manifestation of this disease. What is dactylitis?

2. List 3 symptoms that the patient has complained of?

3. What is meant by “pallor of the conjunctiva”?

4. Does this patient have a heart problem? (give your reasoning)

5. Where are the metacarpals? The metatarsals?

6. Why is it important to know that this patient’s cousin has been recently

diagnosed with a blood disorder?

7. What are erythrocytes? Can you name a disease with abnormally-shaped

erythrocytes, that is seen predominantly in African-Americans?

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