Differential Diagnosis for the 16-year-old boy with progressive shortness of breath
- Single most likely diagnosis
- B. Aplastic crisis: This is the most likely diagnosis given the patient's low hemoglobin level (6.7 g/dL), low reticulocyte count (1%), and history of sickle cell disease. An aplastic crisis occurs when there is a temporary shutdown of bone marrow function, leading to a decrease in the production of red blood cells, which can be triggered by parvovirus B19 infection, commonly seen in patients with sickle cell disease.
- Other Likely diagnoses
- D. Hyperhemolytic crisis: Although less likely than aplastic crisis, hyperhemolytic crisis is a possible diagnosis. It is characterized by an increased destruction of red blood cells, which can lead to a rapid decline in hemoglobin levels. However, the low reticulocyte count in this patient makes this diagnosis less likely.
- C. Folate deficiency: Folate deficiency can cause anemia, but it is less likely in this case given the patient's low reticulocyte count and the absence of other symptoms such as weight loss or diarrhea.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- E. Splenic sequestration: Although splenic sequestration is less common in patients with sickle cell disease over 10 years old, it can still occur and is a life-threatening condition. It is characterized by the sequestration of red blood cells in the spleen, leading to a rapid decline in hemoglobin levels.
- A. Adverse drug reaction: While oxycodone is not typically associated with bone marrow suppression, it is essential to consider the possibility of an adverse drug reaction, especially if the patient has been taking the medication for an extended period.
- Rare diagnoses
- Other rare causes of anemia, such as pure red cell aplasia or bone marrow failure syndromes, could be considered, but they are less likely given the patient's history and laboratory results.