Acute sickle cell crisis – management in hospital

This guideline is about the management of acute sickle cell crises in hospital. However there are a couple of points useful for us:

Initial Assessment of a Patient:

The patient will know what their normal crisis is like. If they say it is different, consider other potential causes for their pain.

Assess obs (including temperature and sats).

Drug Management:

  • Expert Patient. Depending on the severity / past experience of pain and analgesia, the patient will know what works for them. Listen to the patient!
  • Repeat medications. Many crises will be managed at home, so the patient may need medication on repeat, or a standby dose at home.
  • It is common for weak and strong opioids to be needed. All patients should also use paracetamol and NSAIDs if not contra-indicated, during a crisis.
  • Adjunctive Medications. They may need an antiemetic and laxatives too.

Beware more significant sequelae:

  • Acute Chest syndrome – beware respiratory symptoms, low sats (< 95%), chest pain or fever.
  • Strokes, osteomyelitis, infections, aplastic crisis and splenic sequestration can all occur.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton locum chambers, and Pallant Medical Chambers Clinical Guidelines Lead Partner.

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