Differential Diagnosis for Sickle Cell Disease Patient with Severe Pain in Hands and Feet

• Single most likely diagnosis:
  • Vaso-occlusive crisis: This is the most common type of crisis in sickle cell disease, characterized by the occlusion of small blood vessels by sickled red blood cells, leading to tissue ischemia and pain. The severe pain in hands and feet is a classic presentation of vaso-occlusive crisis.
• Other Likely diagnoses:
  • Acute chest syndrome: Although it primarily presents with respiratory symptoms, acute chest syndrome can also cause severe pain and can be a consideration, especially if the patient has any respiratory symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Sequestration crisis: This is a life-threatening condition where sickled red blood cells sequester in the spleen, leading to rapid enlargement and potentially fatal complications. Although less common, it's crucial to consider due to its high mortality rate.
  • Aplastic crisis: Caused by infection or other factors leading to bone marrow failure, aplastic crisis can present with severe anemia and might indirectly cause pain due to decreased oxygen delivery to tissues. It's less likely but critical to identify promptly.
• Rare diagnoses:
  • Other rare complications of sickle cell disease, such as osteonecrosis or bone infarcts, could potentially cause severe pain in the hands and feet but are less likely to be the primary cause of the crisis in this context.