Sickle Cell Disease
Sickle Cell Disease
Sickle Cell Disease
Beta S
Beta S
Hemoglobin SC
Beta S
Beta C
Diagnosis
The most widely used blood test for sickle cell disease and
trait is the hemoglobin electrophoresis. A blood sample is
placed in an electric field on filter paper and the different
hemoglobins travel at different speeds to the negative
pole. Click here to see the test for four blood samples:
HbAA -Normal, Hb AS - Trait, Hb SS - Disease, Hb SC
Hb AA HB AS HB SS Hb SC
Start
Hb A
Hb S
Hb C
Diagnosis Sickledex
The presence of sickle hemoglobin can be rapidly
determined by a five minute solubility test (Sickledex).
This test is only helpful by excluding sickle cell disease
when negative in a patient older than six months of age
without severe anemia or a very high fetal hemoglobin
level. It is impossible to separate sickle cell disease from
trait with this test.The test is positive if 10 percent Hb S is
present, making it impossible to separate sickle cell trait
from individuals with disease
Diagnosis - Blood Smear
Microscope view
of long rods in a
sickle red blood
cell
Normal Shape to Sickle
Normal vs. Sickle red cells
Hemoglobin S
Hemoglobin D
Hemoglobin C
Worldwide Distribution
Hemoglobin S
Sickle Cell Disease is found in
Africans, Turks, Greeks, Saudi
Arabians, Egyptians, Iranians,
Italians, Latin Americans and
Asiatic Indians.
Trait vs.. Disease
About half of the hemoglobin in the red cell is sickle and the
cell will exhibit sickling when under severe conditions of low
oxygenation. Hematuria or blood in the urine is the most
common problem. There are case reports of people with sickle
cell trait having more severe sickle related problems when
placed under severe conditions such as extreme pressure and
low oxygen conditions. Those with trait should be advised of
the risks of extreme physical activity, severe pressure
changes, deep sea diving, and the possibility of hematuria.
Trait vs.. Disease
Pedigree
AS AS
AA AS AS SS
There are two genes for hemoglobin, one of which is inherited
from each parent. If one normal gene and one
abnormal gene is passed on by each parent, only half of the
hemoglobin produced will be abnormal and the individual
will be a carrier of the abnormal gene. This is commonly
referred to as having the trait of the disease.
Pedigree
AS AS
AA AS AS SS
Minor role:
Manufactures red blood cells only
toward the end of fetal life and
after birth the function is taken
over by the bone marrow.
Acts as a blood reservoir
Spleen Location
• Soft, purplish-red
organ that lies under
the diaphragm on the
left side of the
abdominal cavity.
• The spleen is like a
filter inside to recycle
old blood cells and
clear bacteria
Spleen Stick
• A tongue depressor
can be used to
measure and track
spleen size
• Place the tip on the
left nipple and
make a mark where
the spleen tip is felt
Spleen Stick
• On one side of the
stick write the
child’s name, sickle
cell type, and
average
hemoglobin level
• One the back put 1/1/98
dates above the line
where the spleen
tip was
What is Splenic Sequestion
• Sudden trapping of blood
within the spleen
• Usually occurs in infants
under 2 years of age
• May be associated with
fever, pain, and
respiratory symptoms.
• Circulatory collapse and
death can occur in less
than thirty minutes.
Treatments For Splenic Sequestion
• Intravenous fluids
• Blood transfusion as necessary
• Spleen removal or splenectomy
Hand Foot Syndrome - Dactylitis
Sickle dactylitis is one of
the first complications in
sickle cell syndromes with
the highest incidence
between ages six months
and two years.
The sickle red cells cause
painful swelling of the
hands and feet. This is
treated with fluids and
pain medication. It usually
will go away in a few days
without any problems.
Kidney
Click Here to
go to STOP
study
Anemia - Jaundice
Anemia or a low red blood cell count,
is lifelong, starting in the first year of
life. The average red cell life is
reduced from a normal of 120 days
down to an average of 10 to 20 days
in sickle cell anemia. This produces
anemia, a high reticulocyte count,
and a bone marrow factory that is
producing 3 to 4 times more red cells
than normal. Other problems related
to the anemia are yellow eyes or
jaundice (elevated indirect
bilirubin),which later in childhood
and early adult life can cause
gallstones
Acute Chest Syndrome
Pneumonias or infections
in the lung, and acute
chest syndrome, caused
by sickling red cells
blocking blood vessels in
the lung, are the most
common complications.
Infections are treated
with antibiotics and
acute chest is treated
with blood transfusions
It’s hard to tell the two
apart so both treatments
are used
Priapism
Priapism is the painful erection
of the penis caused by sickling
red cells.
This complication usually has
an onset at age 5 to 35. It often
occurs as a severe episode
requiring hospitalization
following multiple episodes of
short duration termed
stuttering. Onset in the early
morninga waking the patient is
common. Treatment includes
pain relief, hydration, exchange
transfusion, and surgical shunt
procedures .
Leg Ulcers
Leg ulcers are seen in 10 to
15% of older children and
adults with sickle cell
anemia. They may start as
a simple insect bite or cut
that will not heal. They are
likely caused by poor
circulation to the skin.
Treatment includes saline
wet-to-dry dressings, Unna
boots ,and special wound
dressings. Leg elevation
and use of elastic stockings
are very important to
speed healing.