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Dactylitis, or hand-foot syndrome, occurring before 1 year of age is indeed recognized as a poor prognostic factor in patients with sickle cell disease. This condition indicates that vaso-occlusive episodes are already taking place in the very early stages of life, suggesting a more severe disease course. The occurrence of dactylitis reflects the underlying pathophysiology of SCD, where the sickled red blood cells can obstruct blood flow in small vessels, leading to pain and swelling. Early onset of this complication often correlates with a higher likelihood of subsequent vaso-occlusive crises and more severe manifestations of the disease, contributing to a poorer overall prognosis.

In contrast, other options indicate different perspectives; for example, an increase in hemoglobin levels generally suggests an improvement in the patient’s condition, while consistently low white blood cell counts can indicate better control of infections and inflammation. Presence of fever, while significant in a clinical setting, is a nonspecific symptom and does not intrinsically determine the prognosis of SCD in the same way early dactylitis does. Thus, dactylitis before 1 year serves as an important marker of potential complications and severity in sickle cell disease.