Initial blood work was notable for an undetectable hemoglobin level. The patient had no jaundice or scleral icterus. His physical exam was significant for irritability and a palpable spleen edge approximately 1.5 cm below the costal margin. In the clinic, the patient was afebrile, tachycardic to 152 beats per minute, with a blood pressure of 104/61 mmHg and no tachypnea or desaturations noted at room air. His medications included hydroxyurea, penicillin‐VK, and folic acid. The patient's medical history is significant for five prior hospitalizations during which he was transfused, but had no history of acute chest syndrome or splenic sequestration, with normal splenic ultrasounds documented on prior admissions. Patient's review of symptoms was otherwise negative with no upper respiratory symptoms, no decrease in oral intake, no diarrhea, and no known sick contacts. He received one dose of ibuprofen at home at the time of fever, with no return of fever prior to presentation to the clinic. He presented to his hematologist's outpatient clinic with irritability and an isolated fever of 102☏ approximately 9 h prior to arrival. The patient is a 2‐year 9‐month‐old male diagnosed with homozygous hemoglobin SS disease. We are not aware of any other published cases of COVID‐19 presenting in this manner. We present a case of a pediatric patient with sickle cell disease who presented with severe anemia in the setting of splenic sequestration and COVID‐19. 1 The effects of COVID‐19 on patients with sickle cell disease are not yet well described. The majority of patients with splenic sequestration present with additional clinical symptoms, most commonly fever, and many with a concomitant infection. Splenic sequestration occurs most commonly in the youngest pediatric patients, with a median age of 1.4 years. Splenic sequestration is a potentially life‐threatening complication of sickle cell disease, estimated to have a prevalence of approximately 12%. Pediatric patients with sickle cell disease have varied clinical experiences.
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