Sickle cell anemia case study
Case study sickle cell anemia worksheet
The foot pain had started three weeks prior, and was not alleviated with over-the-counter pain medications. These include: intra-cranial hemorrhage, isolated neuropathies, transverse myelitis, auditory and ocular manifestations, and spinal cord involvement [ 1 ]. As his mother was helping him to his bed, his left leg also became weak. Case presentation On the morning of admission, our patient, a year-old African-American man with sickle cell anemia, felt himself to be in his usual state of health, although he had just been discharged the previous day from a hospitalization for acute chest syndrome. These high-risk children had an increased blood flow in the internal carotid or middle cerebral artery by TCD. He was admitted to the neurologic intensive care unit where he received an exchange transfusion with no significant improvement in his symptoms; subsequent hemoglobin electrophoresis showed HbA 85 percent, HbS 9 percent. There is no known identifiable thrombophilic abnormality that predicts cerebral infarction in sickle cell disease. In addition, diffusion-weighted imaging demonstrated restricted diffusion consistent with a focus of infarction in addition to cord edema and swelling in the gray and white matter of the right side of the cord. The trial was terminated at the first scheduled interim analysis for futility for the composite endpoint, which required superiority of phlebotomy over iron chelation for reducing excess iron stores.
He was admitted to the neurologic intensive care unit where he received an exchange transfusion with no significant improvement in his symptoms; subsequent hemoglobin electrophoresis showed HbA 85 percent, HbS 9 percent. Arrows point to the decrease in edema.
We hope that this report may lead others who care for people with sickle cell disease to be vigilant to the possibility of central nervous system infarction involving the spinal cord.
The results of computed tomography CT angiography of the head and neck were unremarkable.
Full size image Although initially there was almost complete paralysis of his extremities, over the four days he spent in the neurologic ICU, our patient demonstrated slow but steady progress in regaining some motor function of his affected limbs.
On day 10, he was transferred to a rehabilitation facility, where he made gradual but steady progress in regaining motor function. The arrows point to the edema.
Sickle cell anemia case study examples
These studies were conducted in Brazil and Israel; notably the prevalence of the factor V Leiden and the prothrombin gene variant are known to be very low in African-Americans [ 19 ]. Full size image At 18 months post-infarct he presented with complaints of three hours of generalized weakness, worse in his lower extremities in association with a pain crisis. In a study, Novy et al. There is considerable evidence that sickle cell disease represents a hypercoagulable state [ 12 — 15 ]. On examination, vitals were found to be stable and examination was remarkable for a nodular ill-defined mass on the plantar aspect of his left foot. Conclusions It is possible that spinal cord infarction may occur more commonly than previously recognized in sickle cell disease and is missed or misdiagnosed as cerebral infarction. Literature on sickle cell myonecrosis remains sparse and is confined to scattered case reports and series. A repeat MRI scan showed a persistence of slight T2 signal abnormality in the cervical cord, consistent with previous spinal cord infarction. He was admitted to the neurologic intensive care unit where he received an exchange transfusion with no significant improvement in his symptoms; subsequent hemoglobin electrophoresis showed HbA 85 percent, HbS 9 percent. Aortic disease is a frequent culprit with many case reports detailing adverse sequelae following surgical repair of aneurysms, but also aortic thrombosis, and aortic dissection [ 8 ]. On day 10, he was transferred to a rehabilitation facility, where he made gradual but steady progress in regaining motor function. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Currently, at 20 months post-spinal cord infarction, his condition is unchanged.
He was given daily low-dose 81mg aspirin.
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