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Sickle-cell crisis: acute complications 🚨 🩸
For education and revision only. Check current NICE/BNF, specialist guidance and local NHS policy before clinical use. Newly added V19 material has not received independent clinical sign-off.
Acute sickle-cell complications include vaso-occlusive pain, acute chest syndrome, splenic sequestration, stroke, severe infection and aplastic crisis.
Recognise the emergency
- New chest pain, cough, hypoxia or fever in sickle-cell disease raises concern for acute chest syndrome even if chest imaging is initially subtle.
- Neurological deficit, altered consciousness, severe anaemia, shock or splenic enlargement require immediate escalation.
First response
- ABCDE, analgesia promptly, targeted oxygen if hypoxaemic, careful fluid assessment and investigation for infection/anaemia/haemolysis.
- Contact specialist haematology immediately for suspected acute chest syndrome, stroke, severe anaemia or organ failure; transfusion or exchange decisions are specialist-led.
- Use the patient's individual emergency plan and ensure infection risk is treated promptly according to local pathway.
Clinical reasoning: Not all pain in sickle-cell disease is an uncomplicated vaso-occlusive episode; new hypoxia changes urgency.
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