TYPICAL VASO-OCCLUSIVE CRISIS

This patient with known sickle cell disease presents with their classic pain syndrome for a vaso-occlusive crisis. Considered acute chest, stroke, splenic sequestration, and other emergent complications of sickle cell disease. Considered alternate etiologies of this patient’s pain to include fracture, MSK pain, infection/abscess, and other ischemic etiologies but doubt these are likely.

Will plan for pain control using patient’s pain management plan, basic labs/reticulocyte count, likely discharge

ACUTE CHEST SYNDROME

This patient with known SCD presents with chest/back pain consistent with vaso-occlusive crisis but concerning for acute chest syndrome; this presentation is different than the patient’s typical pain crisis. Considered alternate etiologies of chest pain including acute coronary syndromes, PE, pneumothorax or pneumonia but think this is less likely.

Plan: labs, pain control, fluids, low threshold to transfuse to Hb>9, CXR, discuss with hematology, likely admit

SPLENIC SEQUESTRATION OR STROKE

This patient with sickle cell disease presents with altered mental status, highly concerning for severe range anemia or stroke. Splenic sequestration is also on the differential, although ***given this patient’s age it is quite unlikely that they still have functioning splenic tissue. I considered, but think less likely, other etiologies of altered mental status such as infection, metabolic derangements, or ICH. This symptom constellation is concerning given the underlying medical comorbidities.

Plan: basic labs, reticulocyte count, consider hemolysis labs, XR chest, neuroimaging, probable stroke code activation, neuro and hematology consults, admit