Treatment of Complications

Treatment of Pain

The basic objectives for managing a sickle cell crisis are control of pain and rehydration by administration of fluids. Oxygen is typically given for acute chest syndrome. Pain medications can help reduce the severe pain of sickle cell crises. These medications can range from non-prescription pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs, to more powerful narcotics such as the opioid drug morphine. Corticosteroid drugs may also be prescribed.

All patients should have a treatment plan that helps guide them and their families during a pain episode. Plans should outline which medicines to take and when to seek medical help. Patients and families should learn to recognize symptoms early and begin managing with an appropriate amount of pain medication.

Treatment of Acute Chest Syndrome (ACS)

Acute chest syndrome can be fatal and must be treated immediately. Basic treatments include:

• Supplementary oxygen -- this is critical and life saving.
• Administration of fluids -- overhydration should be avoided to reduce the risk of fluid in the lungs.
• Pain relievers
• Bronchoscopy (a diagnostic procedure involving insertion of a tube into the lower airways) may be needed to identify infection.

Other treatments include:

• High-dose intravenous corticosteroids (usually dexamethasone) may speed recovery from acute chest syndrome and reduce the duration of hospitalization.
• Antibiotics that specifically target the organisms (Chlamydia, Mycoplasma) that commonly trigger acute chest syndrome. Such antibiotics include azithromycin, clarithromycin, levofloxacin, and various tetracyclines (tetracyclines are not used for children).
• Transfusions are important early on for rapid improvement in severe cases, especially if fat embolisms have developed.

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Review Date: 01/13/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)