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Acute chest syndrome — MRCPCH FOP MCQ

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HardHaematology and oncologyAcute chest syndromeMRCPCH FOP

A 10-year-old boy with sickle cell disease has chest pain, fever and cough. Oxygen saturation is 89% in air, haemoglobin is below baseline and chest radiograph shows a new right lower-zone infiltrate. What is the most appropriate management?

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Correct answer: A — Admit for oxygen, intravenous antibiotics and urgent haematology review

Fever, chest pain, hypoxia and a new infiltrate in sickle cell disease indicate acute chest syndrome, needing oxygen, antibiotics, analgesia and haematology input. Discharge is unsafe because acute chest syndrome can deteriorate rapidly. Culture results should not delay empirical treatment. The pearl is that incentive spirometry and adequate analgesia help reduce pulmonary complications during painful crises.

Reference: NICE CKS Sickle cell disease; BSH sickle cell acute complications guidance