Sickle cell disease - NYSORA

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Sickle cell disease

Sickle cell disease

Learning objectives

  • Sings and symptoms and management of sickle cell disease

Definition and mechanisms

  • Sickle cell disease is a group of inherited hemoglobinopathies 
  • The most common type is known as sickle cell anemia, other types are sickle cell anemia (HbSS) and the double heterozygote conditions sickle C (HbSC) and sickle thalassemia (HbSThal) 
  • The average life expectancy is 40 to 60 years
  • The dominant hemoglobin (Hb) is replaced by the unstable hemoglobin S resulting in the deformation of the red cell membrane into the characteristic sickle shape
  • These sickle cells become rigid and aggregate, thereby occluding small blood vessels and leading to tissue infarction
  • Hemolysis occurs due to the damaged cell membrane leading to an inflammatory response
  • The major features of sickle cell disease are chronic anemia and the occurrence of sickle cell ‘crises’ in which multiple episodes of tissue infarction occur
  • Crises can be provoked by temperature changes, stress, dehydration, and high altitude

Signs and symptoms

  • Symptoms of sickle cell anemia usually appear around 6 months of age
  • Vary from person to person and may change over time
  • Anemia
  • Episodes of pain
  • Swelling of hands and feet
  • Frequent infections
  • Delayed growth or puberty
  • Vision problems

Complications

Management

Sickle cell disease, hemoglobin S, Hb, limb tourniquets, thromboembolism, oxygen, acute chest syndrome

Suggested reading

  • Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.
  • Wilson, M., Forsyth, P., Whiteside, J.. Haemoglobinopathy and sickle cell disease. Continuing Education in Anaesthesia Critical Care & Pain. 2010. 10, 24–28.

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