Title : Treatment of sickle cell crisis in a pregnant patient complicated by multiple associated comorbidities: A case study
Abstract:
Sickle Cell Disease (SCD) is an inherited hemoglobinopathy present in 8% of the African American population. High-risk complications include acute chest syndrome, avascular necrosis, thromboembolic events, and vaso-occlusive crises, the last of which occurs in 50% of pregnant patients with SCD, challenging therapeutic management. Given the many contraindications associated with SCD treatment, risk-benefit discussions are necessary when treating high-risk pregnant patients with SCD in the presence of pertinent comorbidities. Retrospective chart review of EHR focused on clinical history, laboratory results, imaging, and management. A 35-year-old African American G4P3003 female with a past medical history of sickle cell-β+ thalassemia, osteoarthritis, avascular necrosis of shoulder joint, and DVT presented with her third sickle cell crisis with diffuse arthralgias and chest pain. Treatment included IV fluids and opioids for pain control and ASA and folate to decrease risk of gestational complications and help maintain hemoglobin above 8 mg/dl with blood transfusions. Hydroxyurea was offered to curb the crisis after determining a higher risk of hemolysis from transfusions, although this posed a higher threat to her pregnancy. Her course was further complicated by unrelenting shoulder pain and a positive chlamydia and gonorrhea test. Due to the ongoing SCD crisis and pain, the transition back home was prolonged. While SCD itself makes for a complex treatment plan in pregnancy, further research into treatment options, like the safety of hydroxyurea after the crucial 3-8 weeks gestational period, is warranted to assist in medical decision making to ultimately decrease the frequency of SCD crisis in pregnancy.
Audience Take Away:
- Use of hydroxyurea for SCD in pregnancy (for which it can be teratogenic).
- How pregnancy and SCD reciprocally contribute to the proliferation of symptoms for each other.
- How to account for pertinent comorbidities when treating SCD and pregnancy.
- Types of blood transfusions appropriate for SCD + pregnancy.
