Aplastic crises

Skeletal bone marrow (aplastic crisis), long bones, hand and feet (dactylitis)... 

Treatment of SCD is aimed at the preventing and/or minimizing acute and chronic complications, including infection, acute chest syndrome, neurologic damage, and the various forms of sickle cell crises, including vaso-occlusive pain, splenic sequestration, and aplastic crisis. The acute and chronic complications are summarized in Tables 65-2,65-3, and 65-4. 

Most patients in aplastic crisis will recover spontaneously. Therefore, treatment is supportive. If anemia is severe or symptomatic, transfusion may be indicated. Infection with human parvovirus B19 is the most common cause of aplastic crisis. Isolate infected patients because parvovirus is highly contagious. Pregnant women should avoid contact with infected patients because midtrimester infection with parvovirus may cause hydrops fetalis and stillbirth.6,27... 

RBC transfusions are indicated for acute exacerbation of baseline anemia (e.g., aplastic crisis, hepatic or splenic sequestration, severe hemolysis), severe vasoocclusive episodes, and procedures requiring general anesthesia or ionic contrast. Transfusions might be beneficial in patients with compli-... 

Treatment of aplastic crisis is primarily supportive. Blood transfusions may be indicated for severe or symptomatic anemia. Antibiotic therapy is not warranted because the most common etiology is viral, not bacterial, infection. 

Patients with mild cases of HS often do not need any treatment. However, these patients should be watched carefully for the development of hemolytic or aplastic crisis. Splenectomy is the treatment of choice in moderate-to-severe HS cases. In general, splenectomy is indicated in patients who are continuously anemic or who have a history of gallstone colic or repeated crises. The clinical results of splenectomy for HS are almost uniformly excellent. However, splenectomy in very young children should be postponed to later in childhood because splenectomized infants are more susceptible to serious and potentially lethal infections than are older children and adults. At the time of splenectomy, it is important to identify and remove any accessory spleen otherwise, the operation will... 

Within days following splenectomy, jaundice fades, the hemoglobin concentration rises, and red cell survival usually returns to near normal. Although the number of peripheral blood microspherocytes remains unchanged, the morphological features of accelerated ery-thropoiesis are not observed. Blood transfusion is rarely indicated except during aplastic crisis. At such times, red cell replacement may be lifesaving. 

Treatment of aplastic crisis is primarily supportive. Blood transfusions may be indicated for severe or symptomatic anemia. Antibiotic therapy is not warranted because the most common etiology is viral, not bacterial, infection. Treatment options for splenic sequestration include observation alone, especially for adults because they tend to have milder episodes chronic transfusion to delay splenectomy and splenectomy after a hfe-threatening crisis, after repetitive episodes, or for chronic hypersplenism. 

Some of the clinical consequences in SS disease include megaloblastic erythropoiesis, aplastic crisis, stroke, bone pain crisis, proneness to infection particularly by Pneumococcus, Salmonella, and Haemophilus due to hypos-plenism and acute chest syndrome. Prophylactic use of penicillin and antipneumococcal and Haemophilus vaccines has aided in the management of life-threatening infectious complications of SS disease. Neonatal screening has been used in the identification of infants with sickle cell disease so that risk of infection can be modulated by appropriate immunizations and penicillin prophylaxis. The acute chest syndrome characterized by chest pain is due to clogged pulmonary capillaries in a small number of studies, patients have been treated with inhaled nitric oxide, which dilates blood vessels with clinical improvement. 

Aplastic crisis is characterized by a decrease in the reticulocyte count and a rapidly developing severe anemia. The bone marrow is hypoplastic. There may be associated pain. The crisis is thought to be caused by a viral infection, particularly B19 parvovirus. 5 5 2S... 

Aplastic crisis Supportive care Transfusion for severe symptomatic anemia... 

Indications for red cell transfusions include (1) acute exacerbation of baseline anemia, such as aplastic crisis if the anemia is severe, hepatic or splenic sequestration, or severe hemolysis (2) severe vaso-occlusive episodes, such as ACS, stroke, or acute multiorgan failure and (3) preparation for procedures that require the use of general anesthesia or ionic contrast. Other patients in whom transfusions may be useful include patients with complicated obstetric problems, refractory leg ulcers, or refractory and protracted painful episodes or severe... 

Treatment of aplastic crisis is primarily supportive and most patients recover spontaneously. The patient may need blood transfusions if anemia is severe or symptomatic. Reticulotye count helps to determine if there is red cell production and the need for transfusions. The most common cause for aplastic crisis is acute infection with human parvovirus B19. Parvovirus is contagious therefore infected patients should be placed in isolation. In addition, contact with pregnant health care providers should be avoided because parvovirus infection during the midtrimester of pregnancy may result in hydrops fetalis and... 

Kellermayer R, Faden H, Gross M. Clinical presentation of parvovirus B19 infection in children with aplastic crisis. Pediatr Infect Dis J 2003 22 1100-1101. 

Parvovirus B19 has been associated with asymptomatic infections, erythema infectiosum, acute arthropathy, aplastic crisis, hydrops fetalis, and chronic anemia and red cell aplasia. In addition, parvovirus B19 infection has been recognized as an important cause of severe anemia in immunocompromised leukemic patients receiving chemotherapy. ... 

Cytomegalovirus infection and aplastic crisis in glucose-6-phosphate dehydrogenase deficiency. 

Aplastic Crisis A period during which erythrocyte production ceases. 

---