Acute anaemia in sickle cell disease

Acute anaemia management

Overview

Acute anaemia is a medical emergency in patients with sickle cell disease. It occurs when haemoglobin falls rapidly below the patient's steady-state level or reaches a critically low concentration. Prompt diagnosis, blood transfusion, and treatment of the underlying cause are essential to reduce morbidity and mortality.

Diagnostic criteria

Acute anaemia is diagnosed when either of the following is present:

• Haemoglobin (Hb) <5 g/dL.

• A recent acute drop in haemoglobin of >2 g/dL below the patient's steady-state haemoglobin.

Common causes

Common causes include:

• Infection

• Splenic sequestration

• Haemolytic crisis

• Aplastic crisis

Investigations

Perform the following investigations:

• Full blood picture (FBP)

• Reticulocyte count

• Creatinine

• Bilirubin

• Alanine aminotransferase (ALT)

• Lactate dehydrogenase (LDH)

• Malaria test

• Urine culture and sensitivity

• Blood culture and sensitivity

• Blood grouping and cross-matching

Management

Begin treatment without delay.

• Immediately transfuse packed red blood cells at 10 mL/kg over 4 hours.

• Repeat transfusion as needed according to the blood transfusion protocol.

• Identify and manage the underlying cause of acute anaemia.

• Document the size of the liver and spleen.