Sickle Cell Disease
Presented by: Dr Paul Vanhoutte
As we welcome new families to New Brunswick from the Middle East and Africa, we are likely to see an increased incidence of sickle cell emergencies. Needs assessments in Canada have shown that Emergencies Physicians outside of the major urban centres lack experience and knowledge in dealing with this disease.
Global distribution of the sickle cell gene – from: http://www.nature.com/articles/ncomms1104
Emergency Presentations
- Acute painful episodes
- Acute anemic crisis
- Acute aplastic crisis
- Acute chest syndrome
- Infection
- Splenic sequestration
- Cerebrovascular events
- Avascular necrosis
- Renal complications
- Hepatobiliary complications
- Ophthalmic complications
- Priapism
A recent article and podcast in EM Cases provides a great outline on – Emergency Management of Sickle Cell Disease
Take Home Points
- Treat sickle – acute painful episodes with opiate analgesia.
- Normal vital signs do not exclude sickle – acute painful crisis.
- High index of suspicion for associated sepsis ( meningitis, septic arthritis, osteomyelitis, pneumonia, pyelonephritis)especially if they have a fever
- Check renal function before prescribing NSAIDS
- Supplemental Oxygen only if hypoxic (<92%)
- IV fluids only required if hypotensive/ hypovolemic
