Checklist for acute management of patients with SCD presenting with a focal neurologic deficit
| Checklist . |
|---|
| 1. Immediate assessment by the hematology and neurology service with shared discussion of the assessment and plan. |
| 2. Laboratory evaluation to include at least complete blood count with reticulocyte count, type and cross, prothrombin time, activated partial thromboplastin time, basic metabolic panel, and HbS quantification. |
| 3. Recommended imaging approach (may be institution specific): |
| CT scan of the brain to exclude cerebral hemorrhage, followed by MRI and MRV of the brain after the patient is stable (<6 h). |
| Alternatively, only an MRI and MRV of the brain may be performed if the images can be obtained within 60 min of evaluation and the scan sequence has been set up to detect cerebral hemorrhage. |
| Imaging may require sedation and support of the sedation team (this should be done after hematology and neurology service evaluation). |
| 4. Obtain vascular access and consultation with transfusion medicine team in preparation for blood transfusion. Obtain transfusion consent from patient and/or next of kin. |
| 5. Transfusion therapy approach: |
| Initiate emergent exchange blood transfusion therapy preferred. |
| Initial simple blood transfusion preferred if Hb is <10 gm/dL, followed by an exchange blood transfusion as soon as possible (requires assistance from intensivist for potential admission). |
| Simple transfusion or exchange blood transfusion may not be indicated if the Hb upon admission is >10 gm/dL or <50% of baseline, respectively. |
| 6. Supportive care measures |
| Oxygen administration to keep oxygen saturation >95%. |
| If febrile, blood culture, antipyretics, and antibiotics should be administered. |
| Checklist . |
|---|
| 1. Immediate assessment by the hematology and neurology service with shared discussion of the assessment and plan. |
| 2. Laboratory evaluation to include at least complete blood count with reticulocyte count, type and cross, prothrombin time, activated partial thromboplastin time, basic metabolic panel, and HbS quantification. |
| 3. Recommended imaging approach (may be institution specific): |
| CT scan of the brain to exclude cerebral hemorrhage, followed by MRI and MRV of the brain after the patient is stable (<6 h). |
| Alternatively, only an MRI and MRV of the brain may be performed if the images can be obtained within 60 min of evaluation and the scan sequence has been set up to detect cerebral hemorrhage. |
| Imaging may require sedation and support of the sedation team (this should be done after hematology and neurology service evaluation). |
| 4. Obtain vascular access and consultation with transfusion medicine team in preparation for blood transfusion. Obtain transfusion consent from patient and/or next of kin. |
| 5. Transfusion therapy approach: |
| Initiate emergent exchange blood transfusion therapy preferred. |
| Initial simple blood transfusion preferred if Hb is <10 gm/dL, followed by an exchange blood transfusion as soon as possible (requires assistance from intensivist for potential admission). |
| Simple transfusion or exchange blood transfusion may not be indicated if the Hb upon admission is >10 gm/dL or <50% of baseline, respectively. |
| 6. Supportive care measures |
| Oxygen administration to keep oxygen saturation >95%. |
| If febrile, blood culture, antipyretics, and antibiotics should be administered. |
Adapted from DeBaun50 with permission.