[Vaso-occlusive crises in sickle-cell anemia].
METHODS
Severe pain suddenly occurred in the shaft of the right thigh in a 21-year-old patient of Turkish descent with known homozygotic sickle cell anaemia. He also had marked scleral jaundice and anaemia (haemoglobin 9.1 g/dl). An X-ray film of the lower leg pointed to a bone infarct. Type of pain, partial pressure of oxygen in blood (70 mm Hg), concentration of lactate dehydrogenase and the bilirubin level (4,5 mg/dl) as signs of haemolysis, as well as the fall in haemoglobin, indicated a vascular occlusive crisis in sickle cell anaemia.


METHODS
The symptoms regressed within 8 days of the patient receiving fluids, analgesics and oxygenation by nasal tube. A few weeks later he developed a fever, productive cough and severe pain in joints and abdomen. Blood p02 was 54 mm Hg. Pneumonia in the right lung base was the cause of this renewed life-threatening crisis, which was again associated with haemolysis. Klebsiella having been found in sputum he was treated with cefotaxim (1 g twice daily intravenously) and oxygen insufflation via nasal tube (7 l/min). His condition quickly improved.


CONCLUSIONS
In patients with sickle cell anaemia it is important (1) to regard crises as potentially life-threatening conditions, (2) to detect and treat infections as possible causes early and (3) to provide sufficient oxygen insufflation quickly, especially in pulmonary infections.
Lang
S M
SM
Medizinische Klinik Innenstadt, Universität München.
Adler
S
S
Karbach
U
U
Emmerich
B
B
D000208:Acute Disease; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D007710:Klebsiella Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008297:Male; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013977:Tibia / Q000098:blood supply*; D014421:Turkey / Q000208:ethnology
Vaso-okklusive Krisen bei Sichelzellanämie.