19year old boy with sickle cell crisis and thalasemia

 Mallannagari.Srilekha

Roll No:- 77 MBBS 9th-Sem 

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A 19 year old boy came to the causality with chief complaints of body pains since two days 

The patient is a known case of sickle cell anemia and thalasemia (diagnoses 10years back).

Body pains since two days. Pain in the joints mainly in the knees,elbow.ankle.pain in the legs and backache.

There is history of one episode of vomiting 1 day back in the evening after having milk

In 2008 patient has history of jaundice and came here treated for iron deficiency anemia , jarmo globing was 7gm/dl then.later the patient had few episodes of jaundice later as well ,in 2012 patient was advised to HPLC and diagnosed to have sickle test and thalasemia as sickling test is positive and there is high HbA2-4.7% and HbS of 61.3%..

After diagnosis the patient was advised to maintain haemoglobin >10gm/dl, adequate hydration, avoid NSAIDS.

In 2018 the patient had history of bilateral leg pains and chest pain 

In 2019 again he had bilateral leg pains

In 2022 he has similar crisis on 17/2/22-cured in 4 days

                                                  28/2/22- cured in 6 days

                                                  6/3/22- cured in 6 Days 

This is the 4th episode this year.

No history of fever,cough,burning micturition

PAST HISTORY:

FAMILY HISTORY:

Father- thalasemia trait

Mother-sickle cell trait 

Sister-sickle cell trait

PERSONAL HISTORY 

Diet - mixed

Appetite- decreased 

Sleep- disturbed due to body pains 

Bowel and bladder-regular 

No known drug allergies 

GENERAL EXAMINATION:

patient is conscious ,coherent, cooperative and oriented to Time, place , person.

Well built and well nourished 

Pallor -present



Icterus no

Cyanosis no

Clubbing no 

Lymphadenopathy no 

Edema no 

Vitals

Pulse rate 84 regular , normal volume.

Blood pressure 130/80 mmHg measured  in right arm

Respiratory rate18 cpm

Temperature afebrile

Saturation 99% at room air

Systemic examination:

CVS:S1 and S2 heart sounds heard.

No murmurs heard

RESPIRATORY SYSTEM

Position of the trachea central

BAE present , vesicular breath sounds heard

ABDOMINAL EXAMINATION



Slightly distended abdomen 

Hernial orifices are free.

No free fluid no bruits 

bowel sounds heard 

No tenderness 

Spleen is palpable and liver is not palpable 

CNS examination normal 

INVESTIGATIONS:

USG abdomen showed slight splenomegaly.

ECG 

MANAGEMENT:

1) IV fluids normal saline and ringer lactate 100ml/hr
2)Inj.Tramadol sos
3)Inj.Monocef 1gm od
4)Inj.Optineurin 1 amp in 100 ml NS od 
Monitor blood pressure and pulse rate two hourly 
GRBS 12th hourly 

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