Maqbool Alam, Mohammad Saqib.
Management of painful sickle cell crisis in Pregnancy.
J Coll Physicians Surg Pak Jan ;14(2):115-6.

A 24-year old Saudi woman with homozygous SS sickle cell disease was admitted with a 2-day history of a typical painful episode involving her legs and back. There was no recent febrile illness. She was 28 weeks pregnant and had two children, the youngest being two years old. Past medical history revealed regular hospital admissions for pain crises and red cell transfusions. On examination, she looked ill, pale and icterus. Her vital signs were remarkable for a pulse of 126/minute and temperature of 38.50C. Systemic examination was unremarkable. Pain was localized to lower limbs and back and was deep in nature, the severity being 9 on Visual Analogue Scale (VAS). Laboratory data revealed haemoglobin 7.5 g/dL, corrected reticulocyte count 13%, total leukocyte count 9.7x10e9/L with 73% neutrophils and platelet count 435x10e9/L. Total bilirubin was 57 mmol/L with 46 mmol/L of unconjugated bilirubin. Abdominal ultrasound revealed normal 28-week gestation. She was admitted and immediately started on intravenous dextrose 5% and oxygen supplementation. Morphine was started with a bolus 3 mg I/V and then infusion was given at the rate of 2 mg per hour (0.04 mg/kg/hour) with an infusion pump. Severity of pain was assessed every hour. Two units of red cell packs were transfused. Broad-spectrum antibiotics empirically administered. There was good response to this and dose of morphine was reduced to 1 mg/hour (0.02 mg/kg/hour) after 24 hours. She was pain-free after 3 days of treatment. She was given tablet diclofenac sodium, 50 mg eight hourly, for two days and then discharged from the hospital.

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