Case Study

Case History

Abioye Akachi, a 5 y.o. boy, recently arrived in Australia fromEast Africa. Brought to the Emergency Dept. by his worried parents,who state that he has frequent infections, a poor appetite, appearsto be in pain, is pale and lethargic.

On examination the clinician finds an irritable child withjaundice, splenomegaly and failure to thrive. The clinicianrequests an FBE, ESR, CRP, Haptoglobin, Blood film, Malaria screen,Renal and Liver function tests and to crossmatch one unit ofblood.

FBE Results

FBE parameter Measured Result WCC (x109/L) 8.9 RCC (x1012/L) 2.6 Hb (g/L) 77 Hct (L/L) 0.22 MCV (fL) MCH (pg) MCHC (g/L) RDW (%) 22.4 Platelet Count (x109/L) 137 DWCC (%)                        Neutrophils 40                             Lymphocyte 54                        Monocyte 4                        Basophils 1 nRBC/100WBC   7

Blood film & other results

Test Parameter	Measured Result
Blood film	Marked polychromasia & sickle cells.  Moderateanisocytosis and target cells. Mild spherocytosis, some nucleatedred cells & occasional Howell-Jolly bodies noted.
Malarial screen	ICT card test was equivocal and no malarial parasites were seenon the thin/thick films.  Â
ESR	Elevated/above the reference range.
CRP	Elevated/above the reference range.
RFT	Within reference range.
LFT	Elevated bilirubin and ALT.
Haptoglobin	Within reference range.

1. Define ‘signs’ & ‘symptoms’. Discuss the clinical findingsof the case and correlate to any physiological orpathophysiological processes.
2. Discuss the laboratory results in detail and discuss andcorrelate to any physiological or pathophysiologicalprocesses.
3. State your Provisional Diagnosis.
4. State your Differential Diagnosis/es.
5. Discuss your chosen Provisional Diagnosis and DifferentialDiagnosis/es with justifications for your selections?
6. List all the Further Tests and Results for the PD and DDs?Tabulate your result.
7. Describe the aetiology & pathophysiology for the chosenPD.