Sickle Cell Anemia: Treatment Recomendations

Daisy has severe anemia, type C comminuted, complex spiral irregular femur fracture, rheumatoid arthritis, and migraine. Oxygen treatment, oral or intravenous fluids, and pain medications could be used for pain and complications prevention. Blood transfusion plays a crucial role in the treatment of the patient. In addition, antibiotics and supplements such as folic acid could be prescribed by doctors. Tense muscles can be relieved by using hot packs and heating pads. Showers or baths that are warm may have a similar effect.

Blood transfusion is important for Daisy because she is experiencing sickle cell anemia. When conducting a transfusion of blood, proper blood administration is essential. Transfusions that are unneeded for the patient or unsuitable should be avoided. Human error almost often causes preventable wrong blood in patient occurrences, resulting in deadly reactions due to ABO incompatibility. The cause for a major part of mistransfusions is a pre-transfusion sampling of blood, processing of laboratory samples, and erroneous blood bank component retrieving errors associated with the identification. The final opportunity to eliminate possibly deadly mistransfusion is the identity check between the patient and the blood component.

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For proceeding with an effective blood administration, proper identification of the patient, efficient communication, and documentation are required. To improve the blood administration process, it could be relevant to use electronic transfusion systems and technologies that will help to manage the procedures. It is crucial for the local hospitals to make sure that the entire personnel is involved in the process of clinical transfusion and trained. It is also recommended for the local hospitals to adopt transfusion policies according to the national recommendations. Despite the fact that the law does not require signed consent, valid consent regarding transfusions should be offered by patients. Because of the increased potential of errors, non-essential ‘out of hours’ transfusion requests and nocturnal blood administration should be avoided wherever possible. From the selection of blood donors until the injection of blood into the patient, the quality and safety of blood and blood products must be ensured.

In addition, to cure sickle cell anemia in Daisy, treatment with hydroxyurea and erythropoietin could be handled. Hydroxyurea promotes the generation of fetal hemoglobin (hemoglobin F) in sickle cell anemia patients, which may help to alleviate both the hemolytic and vaso-occlusive symptoms of the disease (Goldberg et al., 1990). Recombinant human erythropoietin may also boost hemoglobin F synthesis, according to early studies. Currently, hydroxyurea is mostly used to treat myeloproliferative disorders patients, where it has been found to cause moderate increases in hemoglobin F levels. Patients with sickle cell illness have shown far more dramatic rises in hemoglobin F levels. Given the risks of long-term administration of any anticancer treatment to individuals with a congenital nonmalignant disease, there is a lot of interest in finding safe ways to boost hemoglobin F production. Recombinant human erythropoietin has proven to be a highly successful and low-toxic treatment for anemia caused by chronic kidney disease.

A standardized workup should be taken as a base when managing anemia. It is essential to provide supportive care to a patient with severe anemia. A new lung should be considered an infection or fluid-related issue in this population. High oxygen concentrations are generally overstated in this population. Fever should be treated in order to prevent abnormal heart rate. In order to minimize oxygen consumption, cooling could be implemented; however, if there is shivering, the oxygen consumption might increase (Sander, 2018). Coagulopathy might also be caused by cooling; that is why it is not recommended to cool patients. For lowering the heart rate and reducing symptoms of tachycardia, a low dose of beta-blocker could be used. It is important to be cautious when using a non-selective β blocker because a high dose might have an undesired influence on the cardiac system. The reason is that it could bring hypoxia to such organs as the brain.

Another approach to reducing the workload on the respiratory system and oxygen consumption is to use mechanical ventilator mechanisms. It is a noteworthy challenge to manage refraining from phlebotomy. In fact, there is no need for a substantial amount of blood draws for treatment. The little amount of blood is required by vented patients, and care for them could be handled daily in order to control the adequacy of oxygen, the pH level, and other relevant parameters (Sander, 2018). Some specific laboratory tests should be obtained if there is an essential requirement for that. Otherwise, extubation is recommended if the Hgb level is estimated at 4.5 g/dl and there is produced ample reticulocytes in the patient’s blood. It is crucial to emphasize that there is a need for mental status control.

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The above-mentioned treatment methods are expected to positively impact the status of the majority of the patients. Those approaches stand for the effective care to be taken for a patient with severe anemia like Daisy. However, if the care is unsuccessful, an artificial oxygen carrier should be used. This will increase the oxygen delivery and make the oxygen level acceptable. Care for patients with severe anemia might be different according to their personal health conditions peculiarities.

Reference

Goldberg, M. A., Brugnara, C., Dover, G. J., Schapira, L., Charache, S., Bunn, H. F. (1990). Treatment of sickle cell anemia with hydroxyurea and erythropoietin. N Engl J Med, 323(6), 366-72.

Sander, A., & Goodnough, L. T. (2018). Management of anemia in patients who decline blood transfusion. American Journal of Hematology.

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