Sickle Cell Disease with Fever Clinical Pathway — Emergency Department

Diagnostic Studies

Evaluate all children for bacteremia with CBC with differential, blood culture
Assess Hgb and reticulocyte count for aplastic crisis
Additional testing is based on history and PE

CBC with Diff Reticulocyte Count Blood Culture	All children Consider: Extra green top for BMP or LFTs Extra purple top (for type and screen)
CXR	New hypoxia Chest pain Clinical suspicion for pneumonia/acute chest syndrome Sickle Cell and Acute Chest Syndrome Inpatient Pathway
Viral Testing	Influenza-like illness Test for COVID Test for influenza during flu season RRP May be helpful in children with prolonged fever
UA POC	Evaluate if clinical suspicion for UTI, history of previous UTI, renal anomaly UTI Pathway If urine POC is positive, send urine culture
Urine HCG	All post-menarchal females and all females > 12 yrs
Type and Screen	Pale, persistent tachycardia, ill-appearing Suspected splenic sequestration Acute chest syndrome Suspected aplastic crisis Hgb < 5 g/dL or Hgb drop > 2 g/dL from baseline Hgb Reticulocyte count < 2% lower than baseline (unless hemoglobin > 10 g/dL)

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Sickle Cell Disease with Fever Clinical Pathway — Emergency Department

Diagnostic Studies

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Sickle Cell Disease with Fever — Diagnostic Studies — Clinical Pathway: Emergency and Outpatient Specialty Care

Sickle Cell Disease with Fever Clinical Pathway — Emergency Department

Diagnostic Studies