Sickle cell disease

26th September 2011 by Louise Hudman

This is really aimed at secondary care, but there are some things we need to be aware of. A useful guideline to read if you have an affected patient.

Preconception Counselling

  • Ask women about intentions regarding pregnancy so they can have proper preconception management.
  • Vaccinations – Hib / MenC (if not had in childhood). Pneumococcus every 5 yrs. Hep B. Flu annually.

Medications advice

  • Hydroxyurea – stop at least 3m before conception
  • ACEi / A2RB – need to stop.
  • NSAIDS only between 12 and 28/40 (adverse effects on fetal development)
  • Crises triggers – dehydration (eg vomiting in pregnancy) / cold / hypoxia / overexertion / stress. Warn women to avoid where possible.
  • Penicillin (they are hyposplenic) – ensure women are on this.
  • Folic Acid – 5mg throughout pregnancy
  • Partner’s Status – ensure this is checked and counselling offered if a high risk phenotype (see the guideline).

Management during Pregnancy

  • If the woman falls pregnant without preconception planning, then ensure that all the above are done as soon as possible.
  • At booking do the blood pressure, MSU and sats.
  • Care will be with the haematologists / obstetricians throughout the pregnancy.
  • Iron – don’t treat with iron unless iron deficiency is proven (as they are often iron overloaded).
  • Aspirin 75mg – should be used from 12/40 (as small increase risk of pre-eclampsia).
  • Viability scan – should be offered at 7 to 9/40 in addition to the dating scan.
  • MSU monthly throughout pregnancy as high risk from an untreated UTI.
  • Crises – If there is any doubt about what is going on, or if this could be a crises, then seek advice. Anyone with chest pain, fever, SOB or not responding to simple analgesia needs referral

Contraception

  • Progesterone only methods are preferred as there is a small increase risk of VTE, but COC can be used too.

Read more

No credit card details needed – it takes two minutes.

Join free trial

Login

Already a member? Login to view this content.

Login

"I started my career as a GP locum last year a week after CCT. I strongly agree with the doctors who praise the NASGP team. If there is no NASGP, there would be no GP locum called Dr Darshanie Seneviratne.

The team is absolutely amazing especially Dr Richard Fieldhouse, Ali Lewis and Jacqui Gumbrell – all providing unbelievable support to us. I've never seen such urgent assistance from any other team at any point in my career. For example when one of my invoices was delayed by a month and a half, Ali was incredibly supportive. It is a very good strength for us as we have support with any issues. I would like to stay with this amazing team forever. "

Dr Darshanie Seneviratne, GP, Essex

See the full list of features within our NASGP membership plans

Membership