Recurrent and unpredictable episodes of vaso-occlusion are the hallmark of .. Intravenous immunoglobulins reverse acute vaso-occlusive crises in sickle cell. The cause of vaso-occlusive crisis (VOC) is believed to be ischemic and cold can precipitate crises. . what has worked in previous crises. One study from Oman reported periorbital swelling during vaso-occlusive crises in five patients The patients ranged in age from 6 to 15 years old. Four of.

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Rouaghe cG. See related patient information handout on practical tips for preventing a sickle cell crisiswritten by the authors of this article. Occlusie parenteral administration, narcotic analgesics can be given using a fixed schedule with rescue doses administered for breakthrough paincontinuous infusion or patient-controlled administration.

Approach to the Vaso-occlusive Crisis in Adults with Sickle Cell Disease

By using this site, you agree to the Terms of Use and Privacy Policy. As predicted by the model above, its administration to SCD mice resulted in decreased leukocyte adhesion, increased leukocyte rolling velocity, dramatic reduction of Vwso capture by the neutrophils, and improved blood flow rates. Effect of propranolol as antiadhesive therapy in sickle cell disease. First in vivo evidence in a sickle cell murine model for the role of leukocytes in initiating Occlhsive.

Approach to Vaso-occlussive Crisis in Adults with Sickle Cell Disease – – American Family Physician

Reassess the patient every 30 minutes for pain severity, sedation, vital signs and respiratory rate. E-selectin—mediated adhesion activates Src kinases, which then leads to the up-regulation of the leukocyte integrin Mac-1 at the leading edge of crawling neutrophils. Administer an opioid analgesic parenterally preferably intravenously on a regular basis in a full therapeutic dosage or by patient-controlled analgesia. A randomized, placebo-controlled, double-blind trial was conducted at a single center in Sudan.


Oxygénothérapie hyperbare dans la crise vaso-occlusive drépanocytaire – EM|consulte

The visual analog scale has been found to be a clinically useful objective parameter for titrating narcotic analgesics and planning hospital discharge. An acute abdominal pain crisis often resembles an intra-abdominal process such as crjse or appendicitis.

Ischemia-reperfusion injury secondary to ongoing, intermittent microvascular occlusions promotes chronic inflammation in SCD by increased oxidant production and increased adhesion of leukocytes to the endothelium, followed by extravasation into the tissues and, finally, damage to the tissues. Ballas SK Complications of sickle cell anemia in adults: Table 2 summarizes novel agents currently in clinical trials.

Bottom The drawings are used to evaluate the spatial distribution of pain. If tolerated, oral rehydration should be used in patients with milder vaso-occlusive crises.

Information from references 24 and 5. Use oxygen therapy only if hypoxemia is present. Fever is common in patients with an uncomplicated vaso-occlusive crisis and does not necessarily indicate the presence of an underlying infection. Frenette 2, 3, 4. The degree of pain relief is based on a scale of zero to percent.

Patient-controlled analgesia offers several unique advantages in the treatment of severe pain occurring in a vaso-occlusive crisis. It is important to recognize a pain crisis early, correct the inciting causes, control pain, maintain euvolemia and, when necessary, administer adequate hemoglobin to decrease the hemoglobin S level.


Crlse leukocytes and platelets also have an activated phenotype.

This content is owned by the AAFP. Epidemiologic data indicate that 5. When a vaso-occlusive crisis lasts longer than seven days, it is important to search for other causes of bone pain, such as osteomyelitis, avascular necrosis and compression deformities. Vqso goal is to reduce sickling by reducing the hemoglobin S level to below 20 percent.

Propranolol was administered to SCD patients in a phase 1 dose escalation study and significantly reduced epinephrine-stimulated SS-RBC adhesion in a dose-dependent manner. Sickle cell vaso-occlusion causes activation of iNKT cells that is decreased by the adenosine Occluaive receptor agonist regadenoson.

A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Ballas SK, Delengowski A. Consider hospital discharge when the patient’s pain is controlled with an orally administered analgesic or no analgesia is needed.

This section is empty. Hydroxyurea and a cGMP-amplifying agent have immediate benefits on acute vaso-occlusive events in sickle cell disease mice. Oxygen therapy in sickle cell disease.

Surprisingly, inhibition of E-selectin abrogates these effects, whereas inhibition of P-selectin has only a partial effect. Choose a single article, issue, or full-access subscription.