A 21-year-old African American female has been admitted with mild dyspnoea and severe back and abdominal pain. Pulse oximetry on room air is 94%.
Full Blood Count report is as follows:
|
Test |
Value |
Normal Adult Range |
|
White Cell Count* |
16.52 x 109/L |
4.0 – 11.0 |
|
Haemoglobin* |
82 g/L |
115 – 155 |
|
Platelets* |
529 x 109/L |
150 – 400 |
|
Haematocrit* |
0.23 |
0.40 – 0.54 |
|
Mean Corpuscular Volume |
93.5 fL |
79 – 99 |
|
Red Cell Count* |
2.47 x 1012/L |
4.5 – 6.5 |
|
Mean Corpuscular Haemoglobin |
33.2 pg |
27 – 34 |
|
Mean Corpuscular Haemoglobin Concetration |
355 g/L |
320 – 360 |
|
Neutrophils % |
58% |
40 – 80 |
Blood film comment:
Target cells – occasional
Spherocytes – occasional
Sickle cells – occasional
Neutrophilia with toxic granulation
a)
Sickle cell crisis
b)
Ensure adequate ABC – in particular supplemental oxygenation to keep saturations above 96%
IV fluids
Adequate analgesia
Investigate possible precipitants.
c)
Haemoglobinopathies
Iron deficiency
Spleen removal
Liver disease
Thalassaemia
Deficiency of enzyme lecithin cholesterol acyl transferase
This is a sickle cell crisis.
What makes it so? well, the sickle cells are a dead giveaway.
The precipitants?
Management of a sickle cell crisis depends somewhat on what sort of crisis it is. They come in vasoocclusive, aplastic and sequestration flavours.
All will require oxygen, analgesia and rehydration.
Most will require blood transfusion.
As for target cells:
You will see lots of target cells in
Fewer target cells are seen in
Okpala, Iheanyi E. "Sickle cell crisis." Practical Management of Haemoglobinopathies (2004): 63-71.
Walker, H. Kenneth, et al. "Peripheral blood smear." (1990). in Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.
Bessis, Marcel. "Codocytes and Target Cells." Corpuscles. Springer Berlin Heidelberg, 1974. 59-64.
Jones, Kathy W. "Evaluation of Cell Morphology and Introduction to Platelet and White Blood Cell Morphology." I do not know which textbook this is form, but it is a chapter which is available for free online ... for now.
Bull, BRIAN S., J. Breton-Gorius, and E. Beutler. "Morphology of the erythron."New York, McGraw Hill (2001): 271-288. - this is an online re-posting of a chapter of Williams' Haematology, but without the figures.