A 2-year-old male presented in PICU from an outlying hospital secondary to altered mental status. Symptoms: Lethargy and decreased activity began approximately 1 day prior to admission. Symptoms of nausea and vomiting on the day of admission. Past medical history : Patient has a past of Hb SS, hemophilia B, history of hemarthrosis, previously treated with factor IX. Brother and maternal grandfather with hemophilia. CT scan of the brain: Left frontal intraparenchymal and a left temporal hemorrhage, with a 1-cm right shift. Effacement of the left lateral ventricle and the third ventricle.
Other examinations: Patient intubated and sedated. T 99.8°F, HR 191, respiratory rate 18, BP 90/61 mm Hg. 2/6 systolic ejection murmur. Spontaneous eye movement. Glasgow coma score 7. Laboratory Analysis: Hb 8.5 g/L, hematocrit 25%, platelets 143,000. WBC 16,800 with 92% granulocytes, 0% bands, 4%…
