Case 304:19 y/o basketball player with dizziness and

headache

• 19 year-old African-American male college basketball player was seen by Student Health Services complaining of dizziness(lightheaded), stomach cramps, and headache. The headache began the day before. He was dizzy when he got up today. Physical examination revealed a healthy appearing young male in no apparent distress. His temperature was 38.5°C. No significant abnormalities were noted except for serous drainage from nose and slight infection of the posterior nasopharynx. Pertinent negative findings included an absence of retinopathy, splenomegaly, or hepatomegaly. Patient had no siblings and both parents were alive and well. His past medical history was unremarkable.

• The patient was thought to have an upper respiratory viral infection and was treated symptomatically (acetaminophen and decongestants). A CBC was drawn and a throat culture done because of the fever. He recovered rapidly without complications and resumed basketball practice within three days.

• Hgb:13.2 g/dL, HCT: 40%• RBC: 3.13 X 106 uL• MCV: 84 fL• Nucleated RBC 1/100 WBC’s• WBC 16.4 x 103/uL

– Neutrophil: 12500/uL– Lymphs: 3120/uL– Eosin: 164/uL

• Throat Culture: normal flora (results 3 days later)

Peripheral smear:

smear

• Describe the smear and based on the smear what is your differential

• Because of the blood smear findings, the patient was asked to return and further questioning revealed episodes of transient mild arthralgias which the patient described as athletic injuries. No other problems were noted. Blood was drawn for a sickle test (which was positive) and subsequently a hemoglobin electrophoresis was performed.

* = patient

Other common hemoglobinopathies

CC disease

SS disease

Mechanism of action of SS disease

Anatomic changes in Sickle Disease

Sickle cells clogging capillaies

Avascular necrosis