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HCR 240 CASE STUDY 89- SICKLE CELL ANEMIA
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HCR 240 CASE STUDY 89- SICKLE CELL ANEMIACase Study 89 Sickle Cell Anemia
1. What precipitating factors probably trigger the painful crisis
a. Working out at the gym and playing 3:3 basketball, lack of oxygen during exertion and
dehydration
2. What specifically is causing this patient’s current pain crisis
a. Vasoconstriction in the extremities due to hypoxia. His cells have
started to clump and the vessels are constricting
3. Identify this patient’s two major risk factors for sickle cell anemia
a. He is African American and both of his parents tested positive for
sickle cell trait.
4. Which single clinical finding provided a definitive diagnosis of sickle cell anemia in this patient?
a. Electrophoresis revealed a hemoglobin proption 86.5% HbS
5. Excluding laboratory test results, list a minimum of eight clinical manifestations or complications
from this case that are consistent with a diagnosis of sickle cell anemia.
a. Mild dilation of right ventricle, limited ROM in elbows, wrists, knees and ankles, poor skin
turgor and tenting, lips dry, fatigue, systolic ejection murmur noted, dry skin and acute
sequestration crisis, splenomegaly, dactylitis
6. Identify two subnormal clinical values from the laboratory blood test results in Table 89.2 and
briefly explain why they are abnormal.
a. Hemoglobin 10.9 g/dL, Hematocrit 28.1% both effect each other, the
hematocrit shows the amount of RBCs in blood as being low which
carries the O2 through the body, if they are being destroyed/sickle
they cannot carry the O2, which the hemoglobin is showing by
being low
7. Identify three clinical blood test results from Table 89.2 that were elevated and briefly explain why
they are elevated
a. Elevated bilrubin, indirect bilrubin and reticulocytes are elevated due to hemolysis
8. Does this patient require an adjustment in his daily dose of folate.
a. According to his blood work his levels are too high. A normal range
is 2-20 ng/ml and his are 515 ng/ml. Too much folic acid can hide
pernicious anemia. He should have it adjusted and his B12
checked.
9. Why is this patient taking flunisolide
a. Chronic nasal drainage x 2 years and history of asthma
10. List a minimum of four laboratory blood test results that indicate that hepatic injury has not yet
occurred from sickle cell anemia
a. AST, ALT, Alk Phos, albumin, and protein
11. If both parents are carries of HbS mutatuion, what is the probability that their child will
a. Have sickle cell anemia 25%
b. Be a carrier of HbS mutation 50%
12. If one parent has all of the clinical manifestations of sickle cell anemia and the other parent does
not have sickle cell anemia nor is a carrier of the HbS mutation, what is the probability that their
child will
a. Have sickle cell anemia 0%
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