Sickle cell crisis

Severe sickle cell crisis has been reported. 

Psychostimulant medication can be useful in the treatment of severe, acute pain, such as that seen during a sickle cell crisis (Yaster et al., 2000). Dextroamphetamine and methylphenidate are also effective as adjuvants, as they have independent analgesic effects, and potentiate the effects of opioid analgesics. The increase in alertness afforded by the use of psychostimulants can also allow the use of larger doses of opioids (Yaster et al., 2000). Methylphenidate and dextroamphetamine have been used to diminish the sedative effects of opioid analgesic medication (Yee and Berde, 1991) in adolescent patients with malignancies or sickle crisis, and may also potentiate the effects of analgesics. Doses used by Yee and Berde (1991) were 2.5 to 10 mg bid of methylphenidate, or 2.5 to 5 mg bid of dextroamphetamine. 

Molecular and cellular events leading to sickle cell crisis. 

Sickle-cell anemia becomes most apparent during a sickle-cell crisis when the soft tissues are often acutely painful. Using information provided in the text on the molecular-cellular effects of the sickling of red blood cells, can you provide an explanation for the origin of the pain ... 

Red blood cells pass single file through the capillaries. In a sickle cell crisis the red blood cells jam together, clogging the capillaries. The associated tissues become starved for oxygen, producing the pain of a sickle cell crisis. 

Sowemimo-Coker SO, Meiselman HJ, Fracis Jr, B. Increased circulating EC in sickle cell crisis. Am J Hematol 1989 31 263-265. 

AW, a 25-year-old Afro-Caribbean man, has been admitted to your ward with a sickle cell crisis. AW has a raised temperature and complains of severe pain in his limbs, chest and lower back. His regular medications are ... 

Sickle cell crisis terminated by intravenous urea in sugar solutions—a preliminary report. Amer. J. Med. Sci. 261, 309-324 (1971). 

Reports of delayed transfusion reactions continue to appear and confirm the difficulty of diagnosis. Many allo-antibodies responsible for delayed reactions of various severity have been demonstrated (61,63-69). The specificities include the usual Kidd and Rh antigens/anti-bodies and anti-S. Delayed reactions to the Kell antigens, for example Js(a,b), have been reported (68,69), and anti-FF(b) has also been found to cause a delayed reaction (63). A delayed reaction may occur because of anti-Al production from the group O graft and the reduction of suppressor cell activity by immunosuppressive agents (70). In sickle cell patients a more severe delayed transfusion reaction can be misdiagnosed as sickle cell crisis (71,72). This occurs particularly in patients with U variants (73). 

Diamond WJ, Brown FL Jr, Bitterman P, Klein HG, Davey RJ, Winslow RM. Delayed hemolytic transfusion reaction presenting as sickle-cell crisis. Ann Intern Med 1980 93(2) 231. ... 

In some patients, effective doses cause troublesome effects. For example, in a randomized study of patients with sickle-cell crisis who received either butorphanol 2 mg intramuscularly or morphine 6 mg intramuscularly, adverse effects occurred in 23 and 13% respectively (2). On the other hand, a wide range of doses (4-48 mg/day) over 1 month failed to produce scores indicative of euphoric effects, and the withdrawal syndrome resembled a cyclazocine rather than a morphine abstinence effect (1). 

Prevents and treats C deficiency (scurvy) increases wound healing for bums sickle cell crisis deep vein thrombosis. Megavitamin therapy (massive doses) of vitamins is not recommended it can cause toxicity. 

Homozygous Hemoglobin S (HbSS). In homozygous Hb S, a valine for glutamic acid substitution occurs on both p-globin chains because of the inheritance of mutated P-globin chain genes from both parents. The condition is described as sickle cell anemia or sickle cell disease because of the sickle shaped RBCs that occur when there is a sickle cell crisis and is sometimes written as p p. ... 

CBC analysis of an individual homozygous for Hb S indicates a moderate to a major decreased Hb level (60 to 100 g/L) with a normal to increased MCV and MCH. In individuals with a concurrent thalassemia, the Hb is farther decreased and both the MCV and MCH are lowered. In the neonate the peripheral blood smear shows the occasional sickle and target cells and Howell-Jolly bodies. As a patient s age increases, these features of hyposplenism become increasingly evident. In the adult the percentage of sickle cells observed can be as much as 30% to 40%. In the setting of a sickle cell crisis, fewer sickle cells may be present than when the individuals are clinically well. Howell-Jolly bodies, target cells, Pappenheimer bodies, boat-shaped cells, and nucleated RBCs are noted. The platelet count and neutrophil counts are elevated. Sometimes blister cells in which the Hb appears to be present in only one half of the cell is observed. 

Women with sickle cell disease are predisposed to occlusion of the microvasculature (because of abnormal, inflexible red blood cells). Studies of women with sickle cell disease have shown no significant differences between OC users and non-users with regard to coagulation studies, blood viscosity measurements, or incidence or severity of painful sickle cell crisis. 

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