Sickle Cell Disease with Infection/Fever

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Description

Infection is a major complication of SCD, causing morbidity and mortality. Many children with sickle cell anemia have significant hemolytic anemia and impaired splenic function. Most individuals with SCD develop functional asplenia (due to recurrent splenic infarction) by the age of five and are therefore immunocompromised.

Common pathogens (encapsulated bacteria)
S. pneumoniae, H. influenzae type b, E. coli, Salmonella, Mycoplasma pneumoniae, Chlamydia pneumoniae, Strep pyogenes, Staph aureus and Neisseria meningitis

Investigations

  • FBC with differential and reticulocyte count
  • RDT for malaria or Malaria Parasite Slide (MPS)
  • Group and save.
  • Total bilirubin and/or LDH
  • Urinalysis
  • Blood culture
  • CXR
  • When clinically indicated - Urea, Creatinine and Electrolytes, Urine culture, Stool culture, lumbar puncture and evaluation for osteomyelitis.

Treatment

  • Admit for intravenous antibiotic if any of the following are present:
    • age < 1yr,
    • temperature >38°C,
    • very ill or toxic appearance
    • history of pneumonia,
    • pulse oximetry reading <90% on room air,
    • Hb <6 g/dL,
    • WBC <5, 000/mm3 or > 30, 000/mm3,
    • platelet count < 100, 000/mm3.
  • Oxygen if indicated.
  • Blood transfusion if Hb < 5 g/dL.
  • Hydration
  • Cover for gram – negative rod with intravenous cephalosporin such as ceftriaxone OR cefotaxime for 7 – 10 days.
  • Consider Ciprofloxacin for suspected Salmonella osteomyelitis.
  • Patient with ACS/severe pneumonia, add erythromycin 50mg/kg/day 6 hourly/ or azithromycin 10 mg/kg daily.
  • Anti-pyretic such as paracetamol.