19 year old male with joint pains

 A 19 year old male student came with a chief complaint of joint pains since four days.

HISTORY OF PRESENT ILLNESS:- 

Patient came to the causality with joint pains since 16/3/2022 
Patient is a known case of sickle cell Anemia and Beta thalassemia.
He had severe joint pains in the past also since 4 years .
He was given IV fluids and antibiotics for the pain.

HISTORY OF PAST ILLNESS:-

In 2008 patient had yellow discoloration of eyes and visited our hospital and was given iron supplements 
In 2012 patient was adviced for HPLC
Patient HbF: 27.7% HbAo: 5.4% HbA2: 4.7 HbS : 61.3 - diagnosed with sickle cell Anemia and Beta thalassemia.
Patient was adviced to take folic acid 5mg everyday.
In 2018 patient had joint pains 1 episode and visited hospital and was given IV fluids and the pain subsided after 4-5 days.
In 2019 again the patient had severe joint pains 1 episode and was given IV fluids.
In 2020 and 2021 also patient had 1 episode of joint pains each year .
In 2022 he had 4 episodes of joint pains since January.
First episode was on 17/1/2022 and lasted for four days
Second episode was on 28/2/3022 and lasted for 6 days
Third episode was on 6/3/2022 and lasted for 6 days
Fourth episode was on 16/3/2022 for which he visited our hospital as the frequency of the occurrence of joint pains increased over the years.

PERSONAL HISTORY:-

Diet:- Mixed 
Appetite :- Loss of appetite 
Bowel and bladder movements :- Regular
Sleep :- Disturbed
Addictions:- No addictions
Allergies :- No allergies
Not a k/c/o HTN, DM, Asthma, TB

FAMILY HISTORY:-

Father HbF: 2.8% HbAo: 82.7% HbA2: 4.9 HbS - diagnosed with Beta thalassemia trait
Mother HbF: 0.4% HbAo: 52.4% HbA2: 3.4 HbS : 37.4- diagnosed with sickle cell trait
Sister HbF: 2.2% HbAo: 51.8% HbA2: 3.2 HbS : 37.7- diagnosed with sickle cell trait

GENERAL EXAMINATION

Patient is concious, coherent and cooperative
Patient is well nourished 
Pallor: Present
Icterus: No
Cyanosis: No
Clubbing : No 
Lymphadenopathy: No
Edema: No 

Vitals 
Temp:- Afebrile
BP- 130/80
PR- 86 bpm
SpO2 - 99%
CVS- S1, S2 +
RS - BAE +
P/A - Spleen palpable
 
INVESTIGATIONS 

On 18/3/22
PERIPHERAL SMEAR
HEMOGRAM
SERUM CREATININE
SERUM MAGNESIUM
LIVER FUNCTION TEST
COMPLETE URINE EXAMINATION
ECG
PROVISIONAL DIAGNOSIS 
Acute painful crisis 
K/c/o Sickle cell Anemia and Beta thalassemia.

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