From the Guidelines
For a patient in sickle cell pain crisis, the most critical laboratory tests to trend include a complete blood count (CBC) with differential, reticulocyte count, comprehensive metabolic panel, lactate dehydrogenase (LDH) and bilirubin levels, blood cultures, and arterial blood gases, as these help assess disease severity, monitor for complications, and guide treatment decisions. When managing a patient in sickle cell pain crisis, it is essential to monitor these laboratory tests to assess the severity of the crisis and potential complications. The CBC with differential is crucial for monitoring hemoglobin levels, white blood cell count, and platelet count, which can indicate the severity of anemia, potential infection, or other complications 1. The reticulocyte count helps assess the bone marrow's response to the crisis, while the comprehensive metabolic panel evaluates kidney and liver function, which are critical in patients with sickle cell disease due to the risk of nephropathy and acute kidney injury during crises. LDH and bilirubin levels are essential for assessing hemolysis, and blood cultures should be ordered if infection is suspected. Arterial blood gases may be necessary if respiratory symptoms are present, indicating potential acute chest syndrome. Additionally, monitoring C-reactive protein or erythrocyte sedimentation rate can help track inflammation, which is a critical component of sickle cell pain crisis management. These tests should be ordered at presentation and followed serially during hospitalization, with the frequency determined by the patient's clinical status, as recommended by recent guidelines 1. Trending these laboratory values is vital for guiding fluid management, evaluating the response to treatment, and making informed decisions about potential transfusions or other interventions, ultimately impacting morbidity, mortality, and quality of life for patients in sickle cell pain crisis. Key considerations include the risk of hyperhemolysis with transfusions, as noted in recent guidelines 1, and the importance of avoiding excessive hydration while maintaining adequate fluid balance, as highlighted in earlier studies 1.
From the Research
Labs to Trend for Sickle Cell Pain Crisis
The following labs are relevant to trend for a patient in sickle cell pain crisis:
- Complete Blood Count (CBC) to monitor hemoglobin (Hb) level, which may range from 7.0 to 11.0 g/dL in steady state condition 2
- Reticulocyte count to assess bone marrow response, although its usefulness in the evaluation of acute vasoocclusive sickle-cell crisis is debated 3
- Hemoglobin distribution width (HDW) to rapidly assess dense red cells, which correlates strongly with the number of dense red cells 4
- Electrolyte panel to monitor for hyperkalemia, which can occur in hyperhemolysis syndrome 5
- Liver function tests to monitor for transaminitis and acute liver failure, which can be a complication of hyperhemolysis syndrome 5
- Lactic acid level to monitor for severe lactic acidosis, which can occur in hyperhemolysis syndrome 5
- Platelet count to monitor for thrombocytopenia, which can occur in hyperhemolysis syndrome 5
Additional Considerations
- It is essential to ask about recent blood transfusions, as hyperhemolysis syndrome can occur after transfusion 5
- Monitoring for signs of hyperhemolysis syndrome, such as a precipitous drop in hemoglobin, is crucial 5
- Trending these labs can help identify complications early and guide management decisions 2, 5, 4, 3