UMEM Educational Pearls

Title: Sickle Cell Disease and Fever

Keywords: sickle cell, HgSS, fever, sepsis (PubMed Search)

Posted: 9/3/2021 by Natasha Smith
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Watch out for Streptococcus pneumoniae sepsis! Patients can look well for several hours, then suddenly decline, leading to shock or death.
Note that nearly half of patients with HgSS will have diminished spleen function by 1 year of age
Start antibiotics early, even if patients are immunized or are taking prophylactic penicillin
Antibiotic recommendations: long-acting cephalosporin +/- Vancomycin
Order CBC, reticulocyte count, blood culture, CXR, and other testing as needed based on presentation
Admit patients with high fever, toxic appearance, infiltrate on CXR, hypoxia, tachypnea not explained by fever, poor intake/dehydration, severely abnormal CBC, history of S. pneumoniae sepsis, pain crisis + fever

References

Miller, Scott and Kusum Viswanathan. "Sickle Cell Anemia with Fever." Atlas of Pediatric Emergency Medicine, 3rd Edition, edited by Binita Shah, McGraw-Hill, 2019, 510-511.