What preventive measures should I advise to patients with sickle cell disease to reduce the frequency of acute crises?

Preventive measures to advise patients with sickle cell disease to reduce the frequency of acute sickle cell crises include:

• Avoiding known triggers: Advise patients to avoid exposure to cold or windy weather, excessive physical activity, and dehydration, as these can precipitate crises.
• Maintaining adequate hydration: Encourage increased fluid intake to prevent dehydration, which may prolong or trigger painful episodes.
• Adherence to prophylactic antibiotics and immunizations: Emphasize the importance of following prescribed prophylactic antibiotic regimens and keeping up to date with immunizations to reduce infection risk, a common precipitant of crises.
• Folic acid supplementation: Recommend folic acid supplementation (e.g., 5 mg every 1–7 days) to support red blood cell production, although its effect on anemia symptoms is unclear.
• Regular clinical follow-up and individual care plans: Ensure patients have an individualised care plan from specialist centres, including guidance on pain management and when to seek medical advice.
• Psychological support: Consider regular psychological support or cognitive behavioural therapy for patients with frequent pain episodes to improve coping strategies.
• Travel precautions: Advise patients that sickle cell disease does not protect against malaria and that malaria can be severe; therefore, strict adherence to malaria prophylaxis and travel immunizations is essential when travelling to endemic areas.
• Hydroxycarbamide treatment: For patients with recurrent hospital admissions for acute chest syndrome or painful crises, hydroxycarbamide may be considered to reduce crisis frequency.

These measures collectively help reduce the frequency and severity of acute sickle cell crises and improve overall disease management in the community setting.

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