The differential showed a left shift with heavy toxic granulation and Döhle bodies. The initial coagulation results are:

PT 12.0 seconds (normal value, 11 to 13 seconds) PTT 26.0 seconds (normal value, <40 seconds)

Insights to the Case Study

This account represents the worst case scenario for a young sickle patient. Patients in this age range who have sickle cell anemia are vulnerable to virulent infections by encapsulated organisms, acute chest syndrome, and dactylitis . When they are admitted to the hospital, coordinated care by a staff knowledgeable about sickle cell complications is increasingly important because time is usually the enemy and the situation can rapidly escalate. In this case, even though the parent mentioned the child's sickle cell diagnosis, he was treated far too casually and not as a young child with special medical needs. Streptococcus pneumoniae grew from his sputum culture and a gram positive organism was seen on Gram stain, but he was not treated aggressively when one considers that his spleen was compromised. Functional asplenia is serious and life threatening, especially if the patient becomes infected with an encapsulated organism. Patients such as this merit special attention. This patient died of overwhelming sepsis due to the streptococcal infection, which triggered DIC and uncontrollable bleeding. His platelet count plummeted to 40,000 within 2 hours of admission and he began to bleed from the venipuncture site. He was too young to withstand the numerous assaults on his body system.

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