From the Guidelines
Fevers in sickle cell crisis require prompt medical attention as they may indicate serious infection, and patients should seek immediate medical care if their temperature is ≥101.3°F or 38.5°C. The management of fevers in sickle cell crisis is crucial to prevent serious complications, and according to the most recent guideline from the Association of Anaesthetists 1, patients with sickle cell disease are at high risk for overwhelming bacterial infections due to functional asplenia. Initial management includes:
- Blood cultures
- Complete blood count
- Broad-spectrum antibiotics such as ceftriaxone 2g IV daily for adults or 50-75 mg/kg/day for children, as recommended by the Pediatrics journal 1
- Acetaminophen (10-15 mg/kg every 4-6 hours, maximum 4g/day for adults) for fever control
- NSAIDs like ibuprofen may also help with pain and inflammation
- Adequate hydration, typically 1.5 times maintenance fluids, to prevent further sickling
- Oxygen should be provided if saturation falls below 95%
It is essential to note that the fever may be part of a vaso-occlusive crisis or indicate serious complications like acute chest syndrome or osteomyelitis. Patients should not delay seeking treatment for fever, as infection is a leading cause of mortality in sickle cell disease, and early antibiotic administration significantly improves outcomes by preventing rapid progression of infection in these immunocompromised individuals 1. The guideline from the Association of Anaesthetists 1 emphasizes the importance of meticulous anaesthetic care and postoperative management to prevent sickle-related complications.
The key to managing fevers in sickle cell crisis is prompt recognition and treatment, and patients should be educated on the importance of seeking immediate medical attention if they experience a fever. The use of broad-spectrum antibiotics, such as ceftriaxone, is crucial in preventing the rapid progression of infection, and adequate hydration and oxygen therapy are essential in preventing further sickling and improving outcomes 1.
From the Research
Fevers in Sickle Cell Crisis
- Fevers in sickle cell disease (SCD) can be a sign of a serious infection, and prompt treatment is crucial to prevent complications 2.
- The incidence of bacteremia in febrile children with SCD is low, and close follow-up within 24 hours and delayed antibiotic administration can be a plausible alternative treatment option in this population 2.
- A study found that outpatient therapy with ceftriaxone and oral cefixime is safe and effective in febrile patients with SCD who meet the criteria for a low risk of sepsis 3.
Causes of Fever in Sickle Cell Patients
- The clinical diagnosis of febrile episodes in SCD children includes confirmed bacterial infection, presumed bacterial infection, and those without bacterial infection 4.
- The most common isolates in SCD patients with fever are Staphylococcus aureus, Streptococcus viridians, Salmonella species, and Escherichia coli 4.
- The incidence of bacteremia and urinary tract infection in febrile SCD patients is 3.0% and 1.5%, respectively 4.
Management of Fever in Sickle Cell Patients
- Early evaluation and management of febrile episodes in SCD patients are crucial to prevent life-threatening complications 4.
- Parents should be aware and observant of the complications of infectious illnesses in SCD patients and seek medical assistance promptly 4.
- Antibiotic treatment approaches for acute chest syndrome in SCD patients are usually prescribed, but there is no standardized approach, and treatment may vary from country to country 5.