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Sickle cell acute chest syndrome — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesSickle cell acute chest syndromeSCE Acute Medicine

A 24-year-old man with sickle cell disease presents with chest pain, fever and dyspnoea. SpO2 is 90% on air, Hb has fallen from baseline 86 to 68 g/L and chest radiograph shows a new right middle-zone infiltrate. What is the most appropriate next step in management?

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

New pulmonary infiltrate with chest symptoms, fever, hypoxia and falling haemoglobin in sickle cell disease is acute chest syndrome. It requires oxygen, antibiotics, analgesia and early haematology input because transfusion may be needed. Pain improvement does not make the pulmonary syndrome safe. Iron therapy does not address acute sickling or hypoxia.

Reference: NICE CG143, BSH sickle cell guideline, BNF