Management of the febrile patient with sickle cell disease

Low grade pyrexia (<38 C) is frequently seen in uncomplicated painful crises and this does not necessarily indicate an infection (unless infection is suspected for other reasons) (1).

• these patients need not receive broad spectrum antibiotics
• routine penicillin V (or an alternative in penicillin allergic patients) should be continued

Patients with temperatures of more than 38 C should be evaluated immediately since life threatening complications are more common in these populations due to hyposplenism:

• clinical examination, blood count, blood/urine/other cultures (according to clinical features) and chest x ray should be mandatory
• start empirical antibiotics immediately after taking culture samples (1)

During assessment special consideration should be given to the following common causes of high fever in SCD:

• Pneumococcal sepsis
• gram negative sepsis
• lower respiratory tract infection
• urinary tract infection
• osteomyelitis (1)

Reference:

• 1. Sickle Cell Society 2008. Standards for the clinical care of adults with sickle cell disease in the UK