BONE MARROW FAILURE! Hemoglobin of 4 gm/dl and Reticulocytes of < 0.5%
High Yield Review - Aplastic Crisis
Case: A 23 y/o African American female with a
medical history of sickle cell anemia, comes to
the emergency department for evaluation of
shortness of breath, fatigue, and
light headedness. She also c/o joint pains in her hands and ankles. All of her symptoms have been worsening over
the past week. She states her baseline hemoglbin is 10 gm/dl.
And she has not had a blood transfusion in many years.
She has pale conjunctiva, and no rash noted, no spleenomegaly noted.
Her Stat Hemogram shows
Hemoglobin of 4 gm/dl ( Her baseline is 10 )
Reticulocytes of 0.5% ( Normal 0.5- 2.5%)
You send for a type and cross, request for packed red blood cells,
and inform the nurse that they patient will need a blood transfusion and supportive care. The patient was also started on IV Fluids, and Oxygen via nasal cannula.
Case Clues - Aplastic Crisis in Sickle Cell
- She has a h/o of sickle cell anemia and her symptoms are worsening, implying an acute worsening on chronic anemia
- Very low Hemoglobin of 4 gm/dl from her baseline of 10 gm/dl
- Very low Reticulocytes of < 0.5 %
- Joint Pains
- No Recent Blood Transfusions
Notable Notes - Aplastic Crisis in Sickle Cell
- Hall mark is decrease in bone marrow -->
Decrease in Erythropoiesis --> Low Hemoglobin and Low Reticulocytes
- The culprit is INFECTIONS: ( Parvo B19, EBV, Staph.Pneumonia and Salmonella)
- Parvo B19 Infection is adults mostly p/w joint pains, no rash
- Treatment is supportive ( Blood Transfusions, IV Fluids, Oxygen )
The Differentials ( Why Not? )
Why not Splenic Sequestration Crisis ?
--> Will have Low Hemoglobin
--> Will have Elevated Reticulocytes
--> Spleenomegaly
--> Common in Children ( This patients an adult )
Why not Hemolytic Crisis ?
--> Will have low hemoglobin
--> Will have Elevated Reticulocytes
--> No h/o recent massive blood transfusions
Know it for the Boards- Aplastic Crisis in Sickle Cell!
- Acute worsening of Anemia in a adult with Sickle Cell suspect
Aplastic Crisis
- Clues for Aplastic Crisis is Low Hemoglobin and Low Reticulocytes
-Aplastic Crisis think INFECTION!
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