Q. A 17-year-old boy who is a known case of sickle cell disease came to the emergency room with severe right upper abdominal pain for the past 24 hours. He states that his abdomen enlarged during the past 24 hours, and his eyes became yellow.
His temperature is 37.1 degrees Celsius (98.8 degrees Fahrenheit), pulse 99/min, respirations 27/min, blood pressure 85/41 mmHg, and O2 saturation 99% on 2 L nasal cannula. On physical examination, he is in moderate distress with jaundiced skin and sclera and a slightly distended abdomen with tenderness to palpation, particularly in the right upper quadrant.
Lab tests show a Hgb 3.6 g/dL, reticulocyte count 6.90%, PT 13 sec, aPTT 35.5 sec, total bilirubin 55.1, direct bilirubin >10, ALP 457 U/L, AST 32 U/L, and ALT 12 U/L. Ultrasound of the abdomen shows hepatomegaly with no ascites.
What is the best management plan for him?