A True Hematologic Emergency

​BY GREGORY TAYLOR, DO, & JACKLYN M​CPARLANE, DO​A 33-year-old woman with a past medical history of sickle cell SS presented to the emergency department with chest pain, difficulty breathing, and a cough for two days. Her chest pain was diffuse, without radiation, and partially reproducible. Her cough was nonproductive, and she also reported fever and chills.The patient noted this was different from her normal back and leg pain from past sickle cell crises. She was following up with a sickle cell specialist, and was compliant with her hydroxyurea treatment.Her temperature was 102.8°F, blood pressure was 94/60 mm Hg, heart rate was 108 bpm, respiratory rate was 26 bpm, and oxygen saturation was 98% on 2 L nasal cannula. She appeared uncomfortable and in distress with slight diaphoresis. Respiratory exam revealed scattered rhonchi throughout her lung fields. Cardiovascular exam showed tachycardia with a regular rhythm but no murmurs, gallops, or rubs. ECG revealed sinus tachycardia.A complete blood count showed a leukocytosis of 30.3 and hemoglobin of 7.1. Her reticulocyte count was elevated at 12%. All other labs were unremarkable. A chest x-ray showed bilateral mid- and lower lung airspace disease, small bilateral effusions, and a stable left subclavian port. (Fig. 1.)​Figure 1.Acute chest syndrome may ultimately be the result of sickling within the microvasculature leading to pulmonary infarction, pulmonary embolism, viral pneumonia, or bacterial pneumonia. Acut...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research