MDM //

with history of SSD Hb SS_, functionally asplenic_, immunizations for encapsulated organisms reportedly up to date, complicated prior by_ avascular necrosis of humerus and femur, and acute chest syndrome_, last transfusion several months prior_, baseline hgb _ now presenting with constellation of symptoms similar to prior acute vasooclusive pain crises without overt trigger. Patient is afebrile, not hypoxic and without dyspnea with low suspicion at this time for acute chest syndrome. Will trend hemoglobin and reticulocyte count to evaluate for possible hemolytic vs aplastic crisis, although low suspicion at this time. No overt worsening of avascular necrosis or osteomyelitis on exam. Nonfocal neuro exam with low suspicion at this time for end organ dysfunction from VOC including CVA, ACS, AKI or hepatobiliary complications. Will continue to monitor, pain control, gentle hydration, and follow up labs.



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