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Acute chest syndrome in sickle cell disease — SCE Acute Medicine MCQ

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HardCancer, palliative care and haematologyAcute chest syndrome in sickle cell diseaseSCE Acute Medicine

A 24-year-old man with sickle cell disease presents with chest pain, fever and increasing breathlessness. Oxygen saturation is 88% on air, haemoglobin is 69 g/L and chest radiograph shows a new left lower-zone infiltrate. He is in severe pain despite oral opioids. What is the most appropriate next step in management?

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Correct answer: C — Give oxygen, antibiotics, adequate analgesia and urgent haematology review for transfusion strategy

New pulmonary infiltrate with hypoxia and chest pain in sickle cell disease is acute chest syndrome, requiring oxygen, antibiotics, analgesia and haematology input for simple or exchange transfusion. Pain must be treated adequately because splinting worsens ventilation. Pulmonary embolism can coexist, but acute chest syndrome is the immediate working diagnosis.

Reference: NICE CG143 sickle cell acute painful episode; BSH sickle cell acute chest syndrome guidance