Name of treatment regimen

University Hospitals/Ireland Cancer Center

Sickle Cell Inpatient Treatment Guidelines

Supportive Care
Sickle Cell Guidelines
• If patient is hypovolemic on admission, hydrate with Normal Saline @ 300 - 500 • If patient is euvolemic on admission or becomes euvolemic after hydration, hydrate with D5W1/2NS at 75-125 ml/hr continuously.
Laboratory/Radiology
All patients on admission should have the following parameters obtained: • CBC with diff and reticulocyte count, basic metabolic and hepatic panels. • Women: urine beta-HCG • Blood cultures, urinalysis with culture if needed
Transfusions
• Transfuse PRBC's if the Hgb drops >3 g below baseline. • Transfuse PRBC's for symptomatic anemia i.e. shortness of breath, dyspnea on exertion or orthostasis. Sickle Cell Crisis is NOT a symptom of anemia.
Pain Medications
• All narcotic bolus doses should be given as IVPB • If there is no IV access, analgesics may be given IM or SQ. • If the patient is on chronic long acting narcotics, continue the same. • For initial pain relief give Morphine 5 - 10 mg IV and repeat every 1 hr prn pain until pain improves or Dilaudid 1 - 2 mg IV and repeat every 2 hr prn pain until pain improves. • When patient has obtained adequate pain relief with bolus narcotics within the first 2 hours of admission begin PCA with morphine at 1 - 2 mg demand or dilaudid at 0.2 - 0.4 mg demand with a 6 min lock out. • If the patient is not on chronic long acting narcotics consider adding a basal rate • Breakthrough pain medications to be given equivalent to a 1 hour demand if needed. Give one time doses. If frequent breakthrough doses needed, increase PCA demand dose. • If no contraindications to NSAID such as renal dysfunction, GI bleed, PUD or GERD may add ketorolac 30 mg IV every 6 hrs x a maximum of 5 day. • Re-assess frequently. Increase PCA doses by 25% if needed. MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________ University Hospitals/Ireland Cancer Center

Sickle Cell Inpatient Treatment Guidelines

Supportive Care
Sickle Cell Guidelines

Respiratory
• Incentive spirometry at bedside • Routine use of supplemental oxygen is not recommended unless oxygen
Ancillary Medications
• For itching: diphenhydramine 25-50 mg po every 4-6 hrs or hydroxyzine 25-50 • Antibiotics, other home meds as needed as needed.
Chronic Care
• Ferritin concentration if not drawn in the previous 12 months • Echocardiogram if not done in the previous 24 months • Pneumococcal, meningococcal and influenza vaccinations if not previously given • Pulmonary Hypertension consult if needed.
Special Situations
• Acute chest syndrome presenting as new infiltrates, hypoxia, and chest pain may require exchange transfusion and a transfusion medicine consult should be obtained. For mild symptoms PRBC's should be given. MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________

Source: http://www.cwrumedicine.org/images/current_residents/sicklecellguidelines.pdf