From the Guidelines
I strongly recommend close monitoring of this patient's platelet count and consideration of hydroxyurea therapy if not already prescribed, as the patient's platelet count has increased significantly from 759 to 912, indicating thrombocytosis which can be a complication in sickle cell disease. The patient's platelet count has increased significantly, indicating thrombocytosis, which can be a complication in sickle cell disease. While there are no current signs of bleeding, elevated platelets increase the risk of thrombotic events, particularly concerning in sickle cell patients who already have heightened thrombotic risk. Hydroxyurea at an initial dose of 15-20 mg/kg/day can help reduce platelet counts and decrease sickling events, as suggested by recent guidelines 1.
Key Considerations
- The patient's thrombocytosis may be reactive to the current sickle cell crisis or could indicate disease progression.
- Platelet counts should be monitored every 1-2 days during the acute crisis, with hematology consultation if counts continue to rise above 1000×10^9/L or if any thrombotic symptoms develop.
- Additionally, I recommend hydration therapy, pain management as needed, and consideration of aspirin 81mg daily if there are no contraindications to reduce thrombotic risk, in line with expert consensus opinion 1.
- The guidelines from the Association of Anaesthetists also emphasize the importance of meticulous peri-operative care and transfusion, while avoiding unnecessary transfusion to reduce the risk of allo-immunisation 1.
Management
- Close monitoring of the patient's platelet count and other vital signs is crucial.
- Hydroxyurea therapy should be considered if not already prescribed, with careful monitoring of the patient's response.
- Hydration therapy and pain management should be tailored to the patient's needs, with consideration of multimodal postoperative analgesia techniques if necessary.
- Aspirin 81mg daily may be considered to reduce thrombotic risk, if there are no contraindications.
From the Research
Patient Profile
- Patient is experiencing a sickle cell crisis
- Platelet count (PLT) has increased from 759 to 912
- No signs of bleeding are present
Relevant Studies
- A study from 2015 2 found that elevated steady-state platelet counts are associated with frequent emergency room use in adults with sickle cell anemia
- The study suggests that patients with elevated platelet counts may be at higher risk for frequent ED utilization and could be candidates for early and aggressive therapy with disease-modifying agents
- Another study from 1988 3 found that platelet counts are elevated during steady-state sickle cell disease, but do not change during the evolution of a painful crisis episode
- A study from 2006 4 found that platelet activation is significant in sickle cell anaemia, and that platelet counts are significantly raised in steady-state patients
Key Findings
- Elevated platelet counts are associated with frequent emergency room use in adults with sickle cell anemia 2
- Platelet activation is significant in sickle cell anaemia, and may contribute to the vascular occlusion that underlies much of the morbidity in the disease 4
- Platelet counts are elevated during steady-state sickle cell disease, but do not change during the evolution of a painful crisis episode 3
Laboratory Parameters
- Platelet count (PLT) has increased from 759 to 912
- No other laboratory parameters are mentioned in the patient profile
- Studies suggest that other laboratory parameters, such as white blood cell count and hemoglobin level, may also be relevant in assessing the risk of frequent ED utilization in adults with sickle cell anemia 2