Do patients with sickle cell disease (SCD) do better in hot or cold temperatures?

Temperature Management in Sickle Cell Disease

Patients with sickle cell disease do better in warm temperatures and must avoid cold exposure, as hypothermia triggers shivering, peripheral stasis, hypoxia, and increased sickling that can precipitate vaso-occlusive crises.

Core Temperature Principle

Maintaining normothermia is critical for preventing sickle cell complications. Cold temperatures directly cause red blood cell sickling through multiple mechanisms 1:

• Hypothermia leads to shivering and peripheral vasoconstriction, which reduces blood flow and oxygen delivery to tissues 1
• Peripheral stasis from cold exposure increases local hypoxia, creating ideal conditions for hemoglobin S polymerization and sickling 1
• Cold-induced vasoconstriction promotes vaso-occlusive crises by slowing blood flow in small vessels 1

Clinical Evidence on Temperature Extremes

While the Association of Anaesthetists guidelines strongly emphasize avoiding hypothermia 1, epidemiologic data on ambient temperature effects shows mixed results:

• A 2003 study found only weak correlations between daily ambient temperatures and emergency department visits for sickle cell crises 2
• Both extreme cold (<32°F) and extreme heat (>80°F) showed statistical but not clinically significant associations with crisis frequency 2
• The relationship between temperature changes and crisis occurrence remains inconsistent in population-level data 2

However, this epidemiologic uncertainty does not diminish the clear physiologic imperative to maintain normothermia in clinical settings.

Practical Temperature Management

Active warming measures should be implemented routinely 1:

• Increase ambient room temperature in clinical areas where patients are being treated 1
• Use warm blankets to maintain body temperature 1
• Administer warmed intravenous fluids during hydration therapy 1
• Apply active warming devices in perioperative settings 1
• Monitor temperature regularly to detect early hypothermia 1

Avoid all cold applications:

• Never use ice packs on sickle cell patients, even for localized pain 1
• Avoid unnecessary exposure to cold environments 1
• Prevent heat loss during procedures or when patients are sedated 1

Special Considerations

A temperature spike may paradoxically indicate sickling rather than infection alone, requiring careful clinical assessment 1. When fever occurs (≥38.0°C), obtain blood cultures and initiate antibiotics for suspected sepsis 3, 4.

Warmed intravenous saline is well-tolerated and improves patient comfort, though a 2020 randomized trial found no difference in admission rates, pain scores, or opioid requirements compared to room-temperature fluids 5. The comfort benefit alone supports using warmed fluids 5.

Common Pitfalls to Avoid

• Do not assume room temperature is adequate—actively warm patients rather than relying on passive measures 1
• Do not apply cold therapy for pain management as you might in other patient populations 1
• Do not overlook environmental temperature in outpatient settings where patients may be exposed to air conditioning 1
• Do not confuse fever from infection with temperature elevation from sickling—both require prompt evaluation 1, 3