emergency management
Last reviewed 01/2018
When presented with a sickle cell crisis the precipitating stress should be removed, ie treat hypoxia, infection or hypothermia. A febrile patient should be assumed to be infected and requires broad-spectrum antibiotics.
The patient is often dehydrated. This is corrected by i.v. infusion of 0.9% N saline and 5% dextrose until the perfusion is corrected and JVP is normal.
Analgesia is essential:
- paracetamol and NSAIDS are effective in the community
- 10 mg morphine may be required for severe pain in adults
- patient controlled analgesia is particularly effective
Hypoxia and acidosis will both result in more severe sickling. 100% oxygen by face mask and sodium bicarbonate infusion may be required.
Patients with sickle cell anaemia will have accomodated to a haemoglobin of around 9.0 g/100 ml; for this reason, only anaemia of less than 6.0 g/100 ml should be treated by blood transfusion.
The patient should be reassured and encouraged to rest.
Careful monitoring will allow the early diagnosis of further complications such as splenic sequestration or acute chest syndrome.