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Doctors Lounge - Hematology Answers
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| Jpoy
- Sun Nov 25, 2007 2:50 am |
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34 y/o African American male with history of sickle cell disease, presents with worsening respiratory status. Hypoxic with wheezes on auscultation. CXR shows possible infiltrate left lower lobe. Hemoglobin has dropped from 12.8 to 9.3 over 4 days. No sickling cells noted on blood smear. Blood cultures positive for streptococcus pneumoniae. Receiving antibiotics (Rocephin and Vancomycin for 4 days). Have had to start supportive respiratory oxygenation. Thinking he may be suffering from acute chest syndrome, but he denies chest pain. What do you think?
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| Dr. Chan Lowe
- Sun Nov 25, 2007 8:52 pm |
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 Hi Jpoy,
Acute chest syndrome should always be considered in cases like this. The treatment, hydration and possibly blood transfusion, will likely be of use in pneumonia as well-at least the hydration part.
Strep. pneumo is a known severe pathogen for sickle cell patients because the sickling causes destruction of the spleen that helps remove organisms such as strep. pneumo.
Aggressive antibiotics are required. Supportive measures such as intubation and mechanical ventilation can be needed in severe pneumonias.
Best wishes.
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