A 23-Year-Old Woman with Known Sickle Cell Disease Comes to the Emergency

question 149

Multiple Choice

A 23-year-old woman with known sickle cell disease comes to the emergency department with a 3-day history of malaise, lethargy, and severe exertional dyspnea.  She has no cough, chest pain, vomiting, or blood in the stool.  Two years ago, she was hospitalized with acute chest syndrome and required mechanical ventilation.  Her last hospitalization was 7 months ago for a painful crisis, and she underwent an exchange transfusion at that time.  Her current medications are hydroxyurea, folic acid, extended-release morphine, and oxycodone for breakthrough pain.
Her temperature is 100° F (37.8° C) , blood pressure is 122/76 mm Hg, and pulse is 112/min and regular.  Oxygen saturation is 96% on room air.  Examination shows pale palms.  Lungs are clear to auscultation.  The abdomen is nontender.
Laboratory results are as follows:
Chest x-ray shows no infiltrates.  Blood cultures show no growth.
Which of the following is the most likely cause of her symptoms?

• A)Hydroxyurea toxicity
• B)Hyperhemolytic syndrome
• C)Iron deficiency
• D)Splenic sequestration
• E)Viral infection

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