RT Book, Section
A1 Kato, Gregory J.
A1 Gladwin, Mark T.
A2 Schmidt, Gregory A.
A2 Kress, John P.
A2 Douglas, Ivor S.
SR Print(0)
ID 1201808646
T1 Sickle Cell Disease
T2 Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
YR 2023
FD 2023
PB McGraw Hill
PP New York, NY
SN 9781264264353
LK accesssurgery.mhmedical.com/content.aspx?aid=1201808646
RD 2024/10/09
AB KEY  POINTSSickle  cell  disease  (SCD)  causes  a  chronic  hemolytic  anemia  associated  with  acute  and  chronic  vaso-occlusion.Baseline  hemodynamic  and  laboratory  values  in  patients  with  SCD  can  be  confused  with  sepsis.Serum  creatinine  levels  of  1  to  1.5  mg/dL  often  indicate  significant  renal  dysfunction.The  most  common  intensive  care  management  problems  in  patients  with  SCD  include  the  acute  chest  syndrome  (ACS),  very  severe  anemia,  sepsis,  stroke,  priapism,  splenic  sequestration,  or  right  heart  failure  associated  with  ACS  and/or  acute  severe  hemolytic  anemia.The  ACS  is  a  form  of  acute  lung  injury  that  occurs  in  10%  to  20%  of  patients  hospitalized  in  vaso-occlusive  pain  crisis,  often  caused  by  fat  embolization  syndrome  or  pneumonia.Secondary  pulmonary  hypertension,  defined  by  right  heart  catheterization  and  often  unrecognized,  occurs  in  10%  of  adult  patients  with  SCD  and  worsens  during  sepsis,  vaso-occlusion,  and  other  medical  stress.Red  cell  transfusion  is  an  important  treatment  for  most  patients  with  SCD  requiring  intensive  care  management.Rapid  exchange  transfusion  is  indicated  for  central  nervous  system  events,  serious  respiratory  disease,  or  multiorgan  failure.Transfusion  management  in  patients  with  SCD  requires  investigation  of  alloimmunization  history.Preoperative  red  cell  transfusion  and  detailed  supportive  care  are  advisable  for  significant  surgery  in  patients  with  SCD.