Evidence-based management of sickle cell disease in the emergency department

Emerg Med Pract. 2011 Aug;13(8):1-20; quiz 20.


Sickle cell disease (SCD) is the most common genetic disease in the US, affecting approximately 100,000 individuals. In SCD, genetically mutated hemoglobin (HbS) forms rigid polymers when deoxygenated, giving red blood cells a characteristic sickled shape. Increased blood viscosity and cell adhesion produce intermittent vaso-occlusion. The vaso-occlusive phenotype of SCD, which is marked by higher hemoglobin, manifests with frequent painful crises and is associated with a higher risk for developing acute chest syndrome. The hemolytic phenotype is characterized by lower baseline levels of hemoglobin and elevated markers of hemolysis. There are no reliable markers of vaso-occlusive crisis (VOC), ie, vital signs and laboratory tests are normal. After intravenous (IV) opiate titration, patient-controlled anesthesia (PCA) pumps are encouraged. Excess IV fluids have been associated with development of atelectasis, a risk factor for acute chest syndrome. Acute chest syndrome has clinical symptoms similar to pneumonia; these patients will develop progressive hypoxemia, acute respiratory distress syndrome, and death if exchange transfusion is not initiated.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Analgesics / therapeutic use
  • Anemia, Sickle Cell / complications
  • Anemia, Sickle Cell / diagnosis*
  • Anemia, Sickle Cell / therapy*
  • Diagnosis, Differential
  • Emergency Service, Hospital / organization & administration*
  • Emergency Treatment*
  • Evidence-Based Medicine
  • Exchange Transfusion, Whole Blood
  • Humans
  • Pain Management
  • Risk Management


  • Analgesics