Day #7 - Sickle Cell Anemia

Today's case was on sickle cell anemia presenting with vaso-occlusive bony crisis. The take home big picture points include:

• IV hydration and correction of hypoxemia
• Exclude or treat infection
• Appropriate analgesia (morphine, hydromorphone) using narcotic sparing treatments such as ketorolac (5 days maximum ketorolac, use with H2/PPI)
• Avoid transfusions unless symptomatic or <50-60.>
• Chest crisis, stroke, splenic crisis should be considered for exchange transfusion
  
• All patients should be on folic acid
• Consider hydroxyurea in those with >=3 episodes/year. See this article.
  

Up to Date has an excellent review of sickle cell anemia that is very comprehensive. We will also have a noon rounds session on sickle cell anemia on August 26th.