How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and
feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why?
The patient is a 21
...
How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and
feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why?
The patient is a 21 month old adopted child from Haiti with unknown biological family history who is
presented with swollen hands and feet with pain after a cold. During the interview, the patient's mother
discussed her past medical history of recurrent upper respiratory infections, and general weakness
during illness, increased fatigue and fussiness. The family history revealed that patient is adopted from
Haiti with unknown biological history. Mother denied other risk factors, injuries, fall and other events. In
light of this information, the patient should be evaluated for differential diagnoses such as inflammatory
response to joints after a viral illness, reactive arthritis, psoriatic arthritis, sickle cell disease, septic
arthritis and juvenile rheumatoid arthritis. To rule out diagnosis multiple diagnostic studies should be
performed. Laboratory and diagnostic tests are tools to gain additional information about the patient,
and when used in conjunction with a thorough history and physical examination, these tests may
confirm a diagnosis or provide valuable information about a patient’s status and response to therapy
that may not be apparent from the history and physical examination alone (Hay, Levin, M. J., Deterding,
R. R., & Abzug, M. J. (2016). When a patient presents with symptoms like Miah a quick and definite
diagnosis is needed to initiate early treatment. The diagnostic tests that will be ordered include
antinuclear antibodies, hemoglobin electrophoresis, retic count, complete blood count (CBC), c-reactive
protein (CRP), liver function panel (LFT), and tuberculin skin test to assess for hematological and
autoimmune conditions. An abdominal X-ray to assessthe patient’s enlarged spleen, X-rays for bilateral
feet and hands for possibilities of fracture, and arthritis are also necessary. A blood culture and
sensitivity to rule out sepsis and infection, and rheumatoid factor to check for rheumatoid arthritis will
be done (i-Human, 2019). The complete blood count will be done a s well as the reticulocyte count and
the lactate dehydrogenase (LDH) help in cases of anemia.
What physical exam findings and diagnostic results would be concerning to you and why? What would
be three differentials in this case?
Miah is 21 month old female presented with fatigue, history of recent upper respiratory illness, swollen
feet and hands with pain and redness, and abdominal distention and pain. Physical assessment findings
are yellow sclera, enlarged spleen, systolic murmur, abdominal pain and distension, swollen joints of
hands and feet with redness and pain. Although vital signs are stable, patient is ill appeared with
generalized fatigue. Diagnostic results that will be concerned are abnormal X-rays with thinning of the
bony cortex of all bones in hands and feet, the CBC shows the presence of normocytic normochromic
anemia with abnormal sickle shaped cells and presence of elevated white blood cells which indicates
inflammatory and infection response, hemoglobin, RBC and hematocrit are decreased along with the
MCV and MCH. There was also the presence of elevated platelet and RDW. The elevated reticulocyte
count was also elevated like in sickle cell anemia. C-reactive protein is elevated as in the case of enlarged
spleen. The elevated LDH and the ESR to show the presence intravascular hemolysis a complication of
sickle cell disease (SCD). According to Gilli, Bastos, Benites, Costa, & Saad (2016) elevation of LDH has
long been considered a clinical marker of intravascular hemolysis, which could contribute to
complications associated with sickle cell disease complications. The abnormal x-ray finding of bone
thinning is the complication of avascular bone necrosis defined by a history of osteonecrosis which is
majorly seen in SCD patients
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