How can I differentiate between a sickle cell crisis and other acute abdominal conditions in a patient with known sickle cell disease?

To differentiate between a sickle cell crisis and other acute abdominal conditions in a patient with known sickle cell disease, conduct a thorough clinical assessment focusing on the nature of pain, associated symptoms, and signs of complications.

Key differentiating features include:

• Characteristics of pain: Sickle cell crisis pain is typically severe, often involving the abdomen but also other sites, and may be accompanied by a history of similar episodes. Pain not controlled by simple analgesia or low-dose opioids warrants urgent attention and may indicate a crisis NICE CKS.
• Signs of infection or sepsis: Fever (temperature ≥38.5°C in adults or ≥38°C in children under 2), dehydration, hypotension, or signs of severe sepsis suggest infection rather than a simple vaso-occlusive crisis and require immediate admission NICE CKS.
• Acute complications: Look for signs of acute chest syndrome (tachypnoea, oxygen saturation drop >5% from baseline, lung consolidation), neurological symptoms, acute fall in haemoglobin, or acute enlargement of spleen or liver, which may mimic or complicate abdominal pain NICE CKS,NICE CG143.
• Alternative diagnoses: If pain is atypical or not responding to standard sickle cell crisis treatment, consider other causes such as infection (e.g., osteomyelitis, abdominal abscess), splenic sequestration, or malignancy. Investigations including blood tests, imaging, and specialist input may be needed NICE CKS,NICE CG143,NICE NG12.
• Use of individual care plans: Patients often have care plans from specialist centres guiding pain management and indications for hospital referral, which can help distinguish crisis from other causes NICE CKS.

In summary, differentiating sickle cell crisis from other acute abdominal conditions relies on clinical assessment of pain characteristics, associated systemic signs, response to analgesia, and vigilance for complications or alternative diagnoses, with prompt referral and investigations as indicated NICE CKS,NICE CG143,NICE NG12.