Resistant Sickle cell crisis !
Scenario: 28 year old male with history of sickle cell crisis presented with priapism. 6 hours past and despite adequate hydration and analgesia, there is no relief ! What is your next option ?
Answer: In case of priapism, you have 2 options. Either call an urologist for aspiration of corpus cavernosum or consult a hematologist for exchange blood transfusion.
Exchange blood transfusion in sickle cell crisis should be consider in following situations:
- No relief in crisis despite adequate hydration and analgesia
- Any sign of stroke
- Pregnancy
- Prophylactic exchange transfusion prior to major surgery. A single exchange transfusion reduces the risk of complications from the general anaesthetic and surgery
- C/O loss of vision in one eye or visual symptoms
- Unresolved painful erection of the penis (priapism)
1. Anemia, Sickle Cell, emedicine.com
