An adolescent with sickle cell anemia is being evaluated. Which laboratory finding should the nurse expect?

• A. Elevated hemoglobin level
• B. Decreased hemoglobin level
• C. Normal white blood cell count
• D. Elevated reticulocyte count

Answer: (B)

Adolescents with sickle cell anemia have chronic hemolytic anemia, so the hemoglobin level is decreased. The sickled red cells are destroyed more rapidly than they’re produced, leading to low Hb. In response, the bone marrow ramps up red cell production, causing an elevated reticulocyte count. So the most expected lab finding is a low hemoglobin concentration. An elevated reticulocyte count can also be present as a compensatory sign, but it doesn’t replace the finding of anemia. A normal white blood cell count isn’t a defining hallmark in this context, and an elevated hemoglobin level would not fit this disease process.