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Acute chest syndrome — SCE Acute Medicine MCQ

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HardCancer, palliative care and haematologyAcute chest syndromeSCE Acute Medicine

A 29-year-old man with sickle cell disease presents with chest pain, fever and breathlessness. SpO2 is 91% on air, Hb is 72 g/L from baseline 88 g/L and chest radiograph shows a new right middle-zone infiltrate. He is tachypnoeic and has widespread wheeze. What is the most appropriate next step in management?

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Correct answer: A — Treat as acute chest syndrome with oxygen, antibiotics, analgesia and urgent haematology review for transfusion

New pulmonary infiltrate with hypoxia, fever and chest pain in sickle cell disease is acute chest syndrome. Management includes oxygen, antibiotics, adequate analgesia, incentive spirometry where appropriate and early haematology review for simple or exchange transfusion depending on severity. It should not be managed as an uncomplicated pain crisis.

Reference: British Society for Haematology Sickle Cell Acute Complications Guideline