Abdominal Pain and Anemia in a Child

Allison King, MD, MPH and John DiPersio, MD, PhD

Washington University School of Medicine, St. Louis, MO

This case was reviewed and updated in June 2013 by Dr. Ted Wun and members of the Teaching Cases Subcommittee.

Copyright of the American Society of Hematology, 2006. ISSN: 1931-6860.

II. PHYSICAL EXAM

Height 100 cm (25th percentile on growth chart)
Weight 15 kg (25th percentile on growth chart)
Temperature 38.9ºC (102ºF)
Heart Rate 135
Respiratory Rate 40
Blood Pressure 100/60 mmHg
Oxygen Saturation Level 87% (normal range: 92%-98%) on room air

HEENT Normocephalic, pupils reactive, tympanic membranes clear, oropharynx clear
Neck No adenopathy
Chest Mild subcostal retractions. Audible rales at lung bases
Heart Tachycardic with III/VI early-peaking crescendo-decrescendo murmur
Abdomen Mild distension, decreased bowel sounds, diffusely tender to palpation
Genitourinary Circumcised, no erection
Extremities Warm
Neurologic Crying, alert boy. Face was symmetric. Moved all extremities.
Skin No ulcers on the extremities

What additional physical findings might occur in patients with sickle cell anemia? Select all that apply.

Frontal bossing
Jaundice
Joint swelling
Splenomegaly

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