doyoudig
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A pt with SS Anemia come to ER with Priaprism for 4 hrs . Rest all is normal . What is the next step of management?
1 oxygenation
2 exchange trnsfusion
3 hydroxy urea
4 surgical
5. IV Hydration
Answer---2 exchange transfusion
exchange
other indications for exchange:
stroke
acute chest syndrome
aplastic crisis
sequestration crisis
A pt with SS Anemia come to ER with Acute Chest Syndrome. Rest all is normal . What is the next step of management
1 oxygenation
2 exchange trnsfusion
3 hydroxy urea
4 surgical
5. IV Hydration
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| doyoudig
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Posts: 613
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oops gave the answer already in 1
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| CocaCola
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| webjeee
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oxygen
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| Justice
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Priapism - IV hydration, not transfusion...
Acute chest syndrome - transfusion, oxygen, respiratory support
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| doyoudig
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hye justice, many sources dont agree on IV Hydartion or transfusion
but from what I could find
in
ACS -- Exchange Transf
Priaprism--Exchange Trans
Stroke-Exchange Trans
Splenic Sequesteration - IV Hydartion n Exchange Transf
This is from UW n http://sickle.bwh.harvard.edu/menu_sickle.html
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| Justice
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Hey doyoudig,
thanks for your note... I am trying to make reason to do exchange transfusion in case of priapism, and I honestly cannot... In case of penile vessel occlusion by sludged RBS the most sound strategy is to try to dilute the "clot" by providing extra volume...
I do trust Harvard' manuals, but I also like eMedicine site, with very clear, professional-oriented articles... Look what I found there:
"... * Simple blood transfusion is indicated in patients in aplastic crisis and acute sequestration crisis (same what you said!!!)
o Exchange blood transfusions are indicated in cases of cerebrovascular accidents and acute chest syndrome. They are performed occasionally in patients with acute sequestration crisis or in cases of priapism that do not resolve after adequate hydration and analgesia (see Priapism). Exchange transfusion consists of replacing the patient's RBCs by normal donor RBCs, decreasing HbS to less than 30%.'''
Finally, I again asked hem-onco fellow sitting by regarding ET in case of priapism, and he laughed at me... 
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| Justice
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Here is the link to the whole article:
http://www.emedicine.com/emerg/topic26.htm
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| doc_clotaire
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Guys , it depends on what they ask you on the question stem !
When ever a patient with Sickle Cell Anemia present to the ER with complaints of ACUTE PAIN and you don ' t know what it is exacly . The .....
NSIM .......................Adequate hydration and supplement oxygenation but you MUST look for precipitating factor like infection ,ect.....
If you find out that it is VASOOCLUSIVE CRISIS ( stroke , priapism , extreme bone pain ect...)
NSIM .......................Exchange Transfusion ( it is indicated whenever there is vasooclusive crisis ,
that is TOTALLY AND UNEQUIVOCALLY TRUE  , NO DOUBT ABOUT IT  )
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| usmle12
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IS I V HYDRATION NOT NEXT STEP IN MG IN ACUT ACHEST SYNDROME N ALL THOSE RATHER THAN EXCHANGE TRANSFUSION FIRST
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| doyoudig
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thx justice n doclaire I will that in mind
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| sprint123
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Hey clotaire /doyoudig/justice :
Can u explain in brief wat is splenic sequestration crisis in sickle cell??
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| Justice
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sprint123 wrote:
Hey clotaire /doyoudig/justice :
Can u explain in brief wat is splenic sequestration crisis in sickle cell??
Same as priapism - large, hot and tender but this is true emergency as the spleen has thin capsule and gets torn easily... Lots of RBC, platelets and WBC are trapped in the spleen because of the splenic vessel architecture ; Hb is low... Occurs suddenly... Sometimes splenectomy serves better than transfusion...
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| sprint123
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Thanks justice---But doesn't auto-splenectomy occurs in patients with sickle cell very early???
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| Justice
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Well, yes it does... The scinario we are given is kind of out of life, same as 65 year-old female having regular monogamous sex with her husband (one of the case in OBGYN section)...
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