The complications of sickle cell disease (SCD) in pediatric patients are some of the more common chronic conditions that present to the emergency department. It is important that emergency clinicians understand the features of SCD, its related complications, and the associated diagnostic and therapeutic modalities to provide this patient population with the most evidenced-based and high-quality care.
Our recent issue Emergency Department Management of Acute Pediatric Sickle Cell Disease Complications describes the acute complications and evidence-based emergent management of SCD in pediatric patients.
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Here are a few key points:
- A SCD-related vaso-occlusive pain crisis requires prompt evaluation and timely administration of analgesic medications within the first 30 minutes of triage and 60 minutes of arrival to the emergency department (ED).
- When a patient with SCD presents to the ED with an acute febrile illness (>38.5oC), obtain a CBC, reticulocyte count, and blood culture and administer empiric antibiotic therapy with a third-generation cephalosporin (eg, ceftriaxone) within the first 60 minutes of arrival.
- Acute chest syndrome is defined as a new radiodensity on chest x-ray, with the presence of fever and/or respiratory symptoms. A chest x-ray should be obtained for all patients with SCD who present to the ED with these symptoms.
- Stroke is a potentially catastrophic complication of SCD, and the risk for an ischemic stroke is highest in the first decade of life for individuals with SCD. Current ASH guidelines recommend initiation of blood transfusion as soon as possible upon the recognition of stroke-like symptoms and within 2 hours of onset of neurological symptoms.
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