Sickle Cell Disease with Fever — History and Physical — Clinical Pathway: Emergency and Outpatient Specialty Care

Sickle Cell Disease with Fever Clinical Pathway — Emergency Department

History and Physical

  • SCD causes functional asplenia and immunocompromise which increases risk of life-threatening infections with encapsulated organisms and gram-negative bacteria
    • E.g., S. pneumonia, H. influenzae, Salmonella, E. coli, S. aureus
  • Pneumococcal, HIB vaccination and PCN prophylaxis have reduced but have not eliminated bacteremia and sepsis.
  • Most children < 5-7 yrs of age receive PCN prophylaxis
  • Infants < 1 yr have the highest risk of bacteremia
  • To assess health maintenance, current treatment and complications:
    • Review most recent Hematology Letter
    • Check Snapshot, look under Problem List, click on Sickle Cell Disease Type
History
  • Duration of fever
  • Presence of other symptoms, including pain
  • Hydration
  • Exposures
  • Baseline hemoglobin and pulse oximetry reading
  • Previous admissions, ICU admission
  • Complications of sickle cell disease:
    • Acute chest syndrome (ACS)
    • Aplastic crisis (Parvovirus Infection)
    • Documented bacteremia
    • Stroke, TIA
    • Splenic sequestration
    • Bacteremia/sepsis
  • Gall bladder disease
  • Osteomyelitis, septic arthritis
  • Last dose of ceftriaxone
  • Transfusion history
  • Surgical history, splenectomy
  • Vaccination history including Prevnar status
  • Medications:
    • Penicillin prophylaxis
    • Hydroxyurea
    • Folic acid
    • Pain medications
    • Others
  • Allergies
Physical
  • General appearance, VS, pulse oximetry reading
  • Presence of CVC
  • Jaundice
  • Respiratory status
  • Circulatory status
  • Neurologic status
  • Evidence of focal infection
  • Spleen size
  • Presence of rash or petechiae