q-----11 - medicine_king

[ArchivalUser]

d....

[ArchivalUser]

The answer is D, Education of parents regarding abdominal palpation and temperature taking..

Mass neonatal screening for hemoglobinopathy has made it possible to institute comprehensive care in very early infancy.In the United States, the incidence of SS, SC, and S-beta thalassemia combined is 1:400. Acute splenic sequestration is a serious complication of sickle cell disease, usually occurring in patients under 5 years of age. Sudden massive pooling of blood in the splenic vasculature leads to hypovolemia and circulatory collapse. Early detection of splenomegaly by parents who have been taught the technique of abdominal palpation is an important aspect of patient management. The ability of the spleen to opsonize and phagocytize encapsulated organisms, particularly Streptococcus pneumoniae and Haemophilus influenzae B, is impaired in children with sickle cell disease as early as 6 months of age, and, as a result, they are at an increased risk of infection with these organisms. A temperature of 38.5°C to 39°C (101.3°F to 102.2°F) calls for emergency evaluation even if the child does not look very sick. Without treatment, death from overwhelming sepsis, commonly due to pneumococcus, can occur within hours. Prophylactic oral penicillin early in infancy has been used to prevent pneumococcal infection. All children receive the 7-valent pneumococcal vaccine beginning at 2 months of age, and patients with sickle cell disease receive the 23-valent pneumococcal vaccine beginning at 2 years of age.Invasive H. influenzae B infections have been responsible for significant morbidity and mortality in patients with sickle cell disease. Special efforts should be made to immunize these children, as well as other immunocompromised children, with Hib vaccine as soon as they enter the health care system, even if they are over 5 years of age. Folic acid requirement is increased in sickle cell disease (as in all hemolytic anemias), and therefore supplementation is prudent. Vitamin B12 supplementation is not necessary, and tetracycline is con- traindicated because of damage to teeth; meningococcal vaccine is not indicated in children less than 2 years of age, and immunoglobulins have no place in the therapy for this condition.