Sickle Cell Disease And Other Hemoglobinopathies

Approaches To Emergency Diagnosis And Treatment

Freeman, Lisa MD, FACEP
Taylor, Todd B. MD, FACEP
Lopez, Bernard L. MD, FACEP

Author
Lisa Freeman, MD, FACEP Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, University of Texas Medical School—Houston, Houston, TX.
Peer Reviewers
Todd B. Taylor, MD, FACEP Good Samaritan Regional Medical Center & Phoenix Children's Hospital, Phoenix, AZ; Affiliate Assistant Professor, Division of Clinical Education, Arizona College of Osteopathic Medicine, Phoenix, AZ.
Bernard L. Lopez, MD, FACEP Associate Professor of Surgery, Jefferson Medical College; Director of Clinical Research, Division of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA.

Emergency Medicine Practice 3(12):p 1-22, December 2001.

A 5-year-old boy is brought to the ED with joint pain and fever. His mom tells you he has sickle cell disease, and for the past few days the boy has had a cough and runny nose. The child looks well but has a temperature of 101°F. You wonder, “Do I need a CBC with diff, chest x-ray, and UA? Or does this child just need some Tylenol?”

A 27-year-old man with frequent visits to the ED complains of his usual sickle pain in both knees. He is afebrile and non-toxic-appearing. Again, you wonder, “Is a shot of pain meds enough? Or do I ‘round up the usual suspects’ and get bloodwork (including a reticulocyte count) and start an IV?”

A 2-year-old boy with sickle cell disease presents pale and shocky. What's the next step?