INDEX OF SUSPICION
John Kidd MD1
Donald L. Batisky MD1
Constantine A. Stratakis MD, DSc2
Adolpho Garnica MD3
Benjamin R. Waller III MD1
Landon B. Pendergrass MD1
1 University of Tennessee College of Medicine, Memphis, TN
2 National Institute of Child Health and Human Development, Bethesda, MD
3 Georgetown University Children's Medical Center, Washington, DC
This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 4-year-old boy who has SC (sickle cell-hemoglobin C) hemoglobinopathy comes to the Resident Practice Group Clinic for a preschool evaluation. At present he has no complaints, although he has had several hospital admissions related to febrile illnesses and painful crises from his sickle cell disease. He has been receiving penicillin prophylaxis and folic acid supplementation.
A complete blood count yields the following findings: white blood cell count, 27 900/mm3, with 1% band forms, 19% segmented neutrophils, 26% lymphocytes, 9% monocytes, and 45% eosinophils; hemoglobin, 10.9 g/dL; hematocrit, 31.8%; and platelet count, 464 000/mm3.
Further evaluation is undertaken because of his abnormal hematologic picture, revealing two unsuspected conditions.
Case 2 Presentation
Twins are born after a 29-week first pregnancy to healthy parents.
