Case 34 – update 1

Thanks for all of the great contributions on Twitter via #teamhaem

We have initiated basic treatment for patients with a potential sickle cell crisis:

  • Oxygen if hypoxic
  • Hydration
  • Analgesia
  • Keep warm
  • Low threshold for antibiotics
  • Septic screen

Our patients investigations show:

  • WCC 16.7×10*9/L
  • Neuts 13.3×10*9/L
  • Hb 47g/L (baseline between 75 and 90g/L)
  • PLT 562×10*9/L
  • BHCG negative
  • CXR – some atelectasis and possible effusion on the right side but no air under the diaphragm
  • USS abdo – pending
  • CRP 298

She had a one unit transfusion pre op for optimisation. The operation went well without major complications. We know that she has anti-Fya and anti-C and she has received appropriate blood.

Questions

  • What’s your next step?
  • Possible causes of high CRP?
  • How do you account for the anaemia?

Please reply to us (@teamhaem) on Twitter and always include #teamhaem to allow others to follow your comments. Please join in the debate and learn about haematological problems along the way. The case will continue to  evolve over the coming week so keep checking #teamhaem for more information.

Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality.

TeamHaem are not a position of authority.  It is an educational platform to allow discussion and learning.

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