sickle cell crisis

Question 1

clinical features

Answer 1

Pain:
- Can be anywhere/multiple sites
- Often very severe

May have features of precipitating factor e.g infection

Question 2

investigations

Answer 2

FBC:
- if Hb< 20g/L compared to baseline - transfuse

reticulocytes:
- elevated
- LOW IS WORRYING - APLASTIC

U&E, LFTs, CRP
Blood cultures if fever - aplastic
CXR if fever/chest symptoms - acute chest syndrome

Question 3

what to give patients acutely upon arrival

Answer 3

STRONG OPIATE WITHIN 30 MINS
- ask what works for the patient and if they have a sickle care plan and follow that

if no plan:
- Oxycodone 5-10mg PO or 2.5-5mg SC
- Stat and PRN
- SC if severe/vomiting/prior analgesia
- Regular paracetamol +- ibuprofen

Question 4

supportive care

Answer 4

• ensure adequate hydration
• laxitives/anti metrics PRN with strong analgesia
• VTE prophylaxis important
• incentive spirometry

Question 5

acute chest syndrome differencials

Answer 5

infection, PE, fluid overload, opiate toxicity

Question 6

acute chest pain management

Answer 6

Oxygen to keep sats >94%
Analgesia – as per standard crisis
IV antibiotics if fever
IV hydration
Incentive spirometry