Q: What is the role of exchange transfusion in severe VOC?

Exchange transfusion is indicated for severe/refractory VOC with haemoglobin drop >2 g/dL from baseline, acute chest syndrome, priapism >4 hours, acute stroke, or multi-organ failure. Target HbS <30% post-exchange.

Q: How do I differentiate VOC from osteomyelitis?

Both present with bone pain and fever. VOC pain typically resolves within 5–7 days. Persistent pain with localised tenderness, elevated CRP, and positive blood cultures suggest osteomyelitis. MRI with contrast or bone scan may be needed for differentiation.

Q: What analgesic approach is recommended for VOC?

Mild: acetaminophen + NSAIDs (ibuprofen or ketorolac). Moderate: IV morphine or hydromorphone. Severe: IV patient-controlled analgesia (PCA). All patients should receive adequate fluids, oxygen if hypoxic, and close monitoring for opioid side effects (respiratory depression, constipation).

Question 1

When should acute chest syndrome be suspected?

Accepted Answer

Any VOC patient with new chest pain, cough, tachypnoea, hypoxia (SpO₂ <92% on room air), or fever should be evaluated for ACS. Chest X-ray may show new infiltrate. ACS is the leading cause of death in SCD and requires immediate escalation of care.

Question 2

What is the role of exchange transfusion in severe VOC?

Accepted Answer

Exchange transfusion is indicated for severe/refractory VOC with haemoglobin drop >2 g/dL from baseline, acute chest syndrome, priapism >4 hours, acute stroke, or multi-organ failure. Target HbS <30% post-exchange.

Question 3

How do I differentiate VOC from osteomyelitis?

Accepted Answer

Both present with bone pain and fever. VOC pain typically resolves within 5–7 days. Persistent pain with localised tenderness, elevated CRP, and positive blood cultures suggest osteomyelitis. MRI with contrast or bone scan may be needed for differentiation.

Question 4

What analgesic approach is recommended for VOC?

Accepted Answer

Mild: acetaminophen + NSAIDs (ibuprofen or ketorolac). Moderate: IV morphine or hydromorphone. Severe: IV patient-controlled analgesia (PCA). All patients should receive adequate fluids, oxygen if hypoxic, and close monitoring for opioid side effects (respiratory depression, constipation).