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Cost-Effective Strategies For Patients With Sickle Cell Disease

1. Limit the use of oxygen

Not every patient with a sickle cell crisis requires oxygen. Studies show no benefit to routine administration of oxygen.
Clinical Caveat: Be sure to give oxygen to those who need it—that is, in cases of respiratory distress, ACS, pneumonia, or those with pulse oximetry of less than 94%.

2. Use oral rehydration

IV fluids should be reserved for those with evidence of dehydration or in those with persistent vomiting. Oral fluids may suffice for all other patients.
Clinical Caveat: Toxic or dehydrated patients, along with those with unstable vital signs, require intravenous hydration.

3. Limit bloodwork

Apart from tradition, there are no good data to support (or refute) the use of a CBC or reticulocyte count in the evaluation of the afebrile adult patient with a painful crisis. However, if one is ordered, recognize that both the WBC count and platelet count are higher than normal in patients with SCA due to increased bone marrow activity from chronic hemolysis and autosplenectomy (platelets not able to be
stored in the spleen).
Clinical Caveat: There are somewhat better data supporting the use of CBCs in children. Children are also the ones far more likely to suffer an aplastic crisis, so a measurement of the reticulocyte count may also be valuable. Many physicians routinely obtain a CBC and reticulocyte count in all patients who present with any form of sickle cell complication.

4. Treat pain aggressively

This may be one of the most important cost-saving measures. Patients who receive early, aggressive therapy (usually IV morphine combined with sustained-release oral morphine at discharge) are less likely to require hospital admission.

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Last Modified: 07/23/2017
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