Chest xray Potential Pathogens

• Streptococcus pneumoniae (most common), Haemophilusinfluenzae, Salmonella, Mycoplasma pneumoniae, Chlamydia, and viruses (parvovirus B19)

Bone infarcts or sickling in the periosteum usually is indicated by pain and swelling over an extremity. Osteomyelitis also should also be considered. Salmonella spe cies are the most common cause of osteomyelitis in SCD children, followed by Staphylococcus aureus.9 Select an appropriate antibiotic to cover the suspected organisms empirically.

Cerebrovascular Accidents

Acute neurologic events, such as stroke, will require hospitalization and close monitoring. Patients should have physical and neurologic examinations every 2 hours.9 Acute treatment may include exchange transfusion or simple transfusion to maintain hemoglobin at around 10 g/dL (100 g/L or 6.2 mmol/L) and HbS concentration at less than 30%. Patients with a history of seizure may need anticonvulsants, and interventions for increased intracranial pressure should be initiated if necessary. Children with history of stroke should be initiated on chronic transfusion therapy. Adults presenting with ischemic stroke should be considered for thrombolytic therapy if it has been less than 3 hours since the onset of symptoms.5,9

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