Diagnostically:

Hg:

Retic count

Preg:

Unlikely aplastic crisis given reticulocyte count As detailed in laboratory analysis results.  

Unlikely acute chest given no cardiopulmonary complaints-specifically no shortness of breath, no chest pain, no cough, no fevers, lungs clear to bilateral auscultation

Unlikely infection given afebrile, no infectious symptoms per patient and examination did not reveal any infectious sources.  

Unlikely bony infaraction given no acute pain in any particular joint.

Unlikely biliary pathology given no RUQ abdominal complaints,.

Suspect most likely sickle-cell crisis.

Plan:

Analgesia with narcotics and Toradol  

Hydration

Ecourage optimization of outpatient management to minimize breakthrough occurrences of sickle cells crises.

ED Course:

Analagesia and hydration provided.  

Re-assessed. Required further dosing given patient still complaining on significant pain and requesting additional medication. Does not appear overly sedated and no evidence of respiratory depression. As such, will provide additional analgesia and hydration.