Question

A 20-year-old African-American man is unconscious at presentation. Blood pressure is 115/50 mm Hg; respiratory rate is 24/min, and pulse is 160/min. Body temperature is 100.9°F. There is no clinical history available. Blood is drawn for laboratory testing. The results are shown in the table.

Tests Results
BUN 29 mg/dl
Total bilirubin 3.6 mg/dl
Indirect bilirubin 3.1 mg/dl
LDH 963 U
Creatinine 2.4 mg/dl
Urinalysis 2+protein, Acetone+, Hemoglobin+
RBC 2.1 x 1012/l
Hgb 9.4 gm/dl
Hct 0.28
MCV 81 fl
MCHC 33%
MCH 28 pg
Platelet count 15 x 109/l
WBC 12 x 109/l
Differential
Segs 38%
Bands 15%
Lymphs 37%
Monos 10%
Nucleated RBC's 3 NRBC/100 WBC
Platelets Adequate
Poikilocytosis 4+
Anisocytosis 3+
Target cells Occasional
Spherocytes 2+


Based on the peripheral blood smear - which shows cresent shaped cells and the laboratory results, what is the most likely diagnosis?

Answer 1

The most likely diagnosis for the 20-year-old African-American man is sickle cell crisis, also known as sickle cell anemia. This diagnosis is supported by the presence of cresent shaped cells on the blood smear, low hemoglobin levels, high indirect bilirubin levels, and presence of protein in urine.

Step-by-step explanation:

Based on the peripheral blood smear which shows cresent shaped cells and the laboratory results, the most likely diagnosis for the 20-year-old African-American man is sickle cell crisis, also known as sickle cell anemia. This diagnosis is supported by the presence of cresent shaped cells on the blood smear, which are characteristic of sickle cell disease. The laboratory results also show low hemoglobin levels, high indirect bilirubin levels, and presence of protein in urine, which are all consistent with sickle cell crisis.