What are the BCSH guidelines for treatment of acute chest syndrome (ACS) in patients with sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

British Committee for Standards in Haematology (BCSH) 2015 guidelines for treatment of acute chest syndrome (ACS) recommend use of the following measures [86] :

  • Prompt and adequate pain relief
  • Incentive spirometry – In patients with chest or rib pain, to prevent ACS; should be considered in all patients with ACS
  • Antibiotics, with cover for atypical organisms, even if blood cultures and sputum cultures are negative
  • Anti-viral agents– If there is a clinical suspicion of H1N1 infection
  • Early simple transfusion should be considered early in patients with hypoxia; however, exchange transfusion is necessary in patients with severe clinical features or evidence of progression despite initial simple transfusion
  • Transfused blood should be sickle-negative and fully matched for Rh (C, D, and E type) and Kell antigens; a history of previous red cell antibodies should be sought and appropriate antigen-negative blood given
  • Bronchodilators should be provided in patients with symptoms suggesting a history of asthma or evidence of acute bronchospasm

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