Sickle cell disease Quiz: Ace Your Exams

A 19-year-old woman presents to the emergency department with severe pain in her lower back and hips that started 48 hours ago. Over the past several months, she has had similar, but less severe, episodes of pain in her arms and legs which she initially attributed to physical exertion. She has also had a 2-week history of profound fatigue, pallor, and dark urine. During childhood, she experienced recurrent respiratory infections. Her family is originally from West Africa, and she was born there. Her younger brother has had similar episodes of bone pain. Temperature is 37.1°C (98.8°F), heart rate is 115/min, blood pressure is 118/68 mm Hg, respiratory rate is 20/min, and oxygen saturation is 96% on room air. Physical examination reveals scleral icterus and jaundice. The low back and hip joints are painful with movement and palpation. Which of the following is most likely to be seen on further evaluation?