Patients can present to ER with severe pain in chest, bones etc with history of Sickle Cell Anemia. Usually you can confirm with Hb Electrophoresis which takes more than a day to test. Most of them usually have a history of Sickle cell diagnosis.
ER:
Routine Labs, EKG, CXR
IV Fluids, Encourate PO fluids
Pain Management
Oxygen
Hospitalist:
Continue IV Fluids, Pain Management-usually narcotics with Zofran, Oxygen
Urology consult for Priapism
Hb Electrophoresis if diagnosis needs to be confirmed
Hematology Consult for severe anemia. They may need Folic Acid, Hydroxyurea
Blood Transfusion if very anemic
Minimize too many blood draws
Flu shot, Pneumococcal vaccine prior to discharge.
They may need high doses of iv narcotics. Some may be addicted to narcotics and can demand iv Dilaudid but we should give benefit of doubt to them when they complain of pain.
