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Sickle cell disease fever — DCH MCQ

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HardChronic conditionsSickle cell disease feverDCH

A 6-year-old with HbSS sickle cell disease is fully immunised and adherent to penicillin prophylaxis. They present with a temperature of 38.8°C and appear tired but are haemodynamically stable. Oxygen saturation is 98% in air, with no respiratory symptoms, focal chest signs, pain or splenomegaly. Which investigation should not be omitted from the immediate assessment before empirical intravenous antibiotics are given, provided obtaining it does not delay treatment?

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Correct answer: C — Blood culture

The correct answer is C. Fever above 38°C in a child with sickle cell disease requires urgent assessment for invasive bacterial infection. Functional hyposplenia may be present regardless of whether the spleen is palpable, and vaccination and penicillin prophylaxis reduce but do not eliminate the risk. Blood culture should therefore be obtained before empirical intravenous antibiotics when this can be done without delaying treatment. Viral PCR may supplement rather than replace bacterial investigation. A chest radiograph is indicated if respiratory symptoms, chest signs, hypoxia or other suspicion of acute chest syndrome develops. Ferritin assesses chronic transfusional iron loading, not acute fever. Abdominal ultrasound is not the initial investigation for infection or splenic sequestration in the absence of abdominal findings or splenomegaly.

Reference: NHS Greater Glasgow and Clyde, Sickle Cell Protocol, Haematology, Paediatrics (250), Antibiotics section, last reviewed 12 August 2025. https://www.clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/haematologyoncology/sickle-cell-protocol-haematology-paediatrics-250/