note:
Wound of insect bite/secondaryinfection is a recent complication. The patient has had severe pain episodes in the legs, hips, and even occasionally abdomen for his entire life since infancy without ever having insect wound infections before.

Pt has had "yellow eyes" since he was about 6 months old according to his mom.

I'm leaning towards malaria also.

Is it possible to do slides(stains) in this environment to r/o?

ccrn

Good Job
 

Well, my thread has taken an interesting and important twist that I had not intended.

The correct answer was sickle cell anemia(congrats A.M.) with an acute sickle cell crisis(pain) beginning to occur.

• Genetic condition commonly affecting African race
• anemia/jaundice/spleen and liver damage
• Small stature/failure to thrive due to constant low RBC
• poor wound healing
• #1 cause of early death in untreated SC juveniles is secondary bacterial infection
• present since birth, not an acute illness

Malaria can have most of these signs too. Coincidently, having the sickle cell trait actually gives partial immunity to malaria which is the reason Darwin's laws haven't removed sickle cell from the population over the centuries.

If we encounter this dilemna in the field, how can one attempt to differentiate the two illnesses from one another?

Then we can cover what pallative treatments should be given to someone experienccing a sickle cell crisis.

Re: Good Job
 

Interesting dilemma.

First a brief lab diversion: you could examine the blood under a microscope to look for the malaria parasites (though they may not be present in large concentrations, so you could not rule out malaria that way). Microscope is also used in some countries to do Peripheral Blood Film to screen for sickling. With a better lab, you could perform electrophoresis or HPLC on the hemoglobin to confirm sickling. DNA testing might also be done, though much less likely in a field lab.

Are there any adverse effects of treating the sickle-cell anemia patient with anti-malarial drugs?

I should have seen that.....


I would imagine that differentiation would be within the means of 18D if trained and equiped in the field, and certainly a basic clinic staffed by an MD, by slide (sickle cell erythrocyte vs stains for parasites in bloodcells).

Palliative measures could include but not be limited to:

*Bedrest w/minimul exercise to promote circulation(avoid DVT).
*Hydration either PO or Parental.
*Analgesia to include local adjuncts if possible.
*Strict I/O.
*Monitor lytes especialy Na.
*Keep pt warm, cold is contra-indicated to avoid vaso-occlusion.
*Also monitor for shock(acute sequestration crisis=probably how sibling died), infection, CVA.
*prophylactic ABX tx if possible (broad spectrum?).
*Support parents/family if time available
*Education of village/family

(Edited for clarity)

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