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Department of Pediatrics : Academic Divisions : Emergency Medicine : Resident Manual : Sickle Cell Disease : Fever

Sickle Cell with Fever (T > 101)

Overwhelming bacterial infection is still the leading cause of death in children with sickle cell disease. In the US, sepsis accounts for 38% of all deaths in children under 20 years of age.

1. HISTORY:

  1. when fever started
  2. associated symptoms (e.g. cough, dysuria)
  3. missed penicillin doses
  4. pain

2. PHYSICAL EXAM:

  1. toxic appearance
  2. hypotension, poor perfusion
  3. spleen size
  4. hydration status

3. LABORATORY EVALUATION:

  1. CBC c differential, reticulocyte count, blood culture if 12 years or younger
  2. dip urinalysis (clean catch or bagged specimen) on everyone; culture (via cath if not toilet trained) if female < 2 years of age, male < 9 months of age, OR if symptomatic
  3. chest radiograph if symptomatic
  4. CSF if clinically indicated

4. TREATMENT:

  1. ceftriaxone 75mg/kg IV or IM immediately (do not wait for lab results); max dose 2 gm
  2. once all diagnostic studies are complete, notify heme-onc fellow, and discharge, if eligible, with prescription for Augmentin 45mg/kg/day, divided q 12 hours, for 3 days.
  3. ADMIT if patient has any exclusion criteria (see list following), or is on the exclusion list

5. FOLLOW UP:

  1. make sure phone number is correct
  2. all patients < 6 years old should be seen in 24-48 hours for recheck, either in sickle cell clinic or day treatment clinic at Rutledge Tower. Children 6 or older will have phone follow up, or appointment if needed
  3. call sickle cell doctor on call to schedule follow up
  4. patients are given preprinted discharge instruction sheet that specifies reasons to return sooner
  5. patients with positive blood cultures are called back for parenteral therapy


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