Recommendations for the Emergency Management of a Child with Sickle Cell Disease Who Has a Fever
(Including Children With Sickle Cell Anemia,
Hemoglobin SC Disorder, Sickle Beta Thalassemia)
The following are recommendations for the emergency management of a febrile child with sickle cell disease. These recommendations are not intended to replace your individualized clinical evaluation of each child. It is extremely important that any child with sickle cell disease continue penicillin prophylaxis until, at least age five.
The treatment of a child, with sickle cell disease, who is under four years of age, with a temperature above 101.5- F (38.6-C), should include at a minimum:
- Every child should be seen by a primary health care provider who is knowledgeable in the care of children with sickle cell disease.
- A long-acting antibiotic (effective against streptococcus pneumonia and hemophilus influenzae) should be given IM or IV.
- The child should be observed for at least four hours after the parenteral antibiotic is given.
- The child should be re-evaluated 24 hours after administration of the parenteral antibiotic.
- Antibiotics should be continued for at least three (3) days
- The child should be admitted if there is no reliable caregiver or source of primary care for follow-up.
The above treatment is recommended whether or not the child has a focal source for the fever.
It is recommended that a CBC (with differential and reticulocyte count) and a blood culture be obtained, if it all possible.
This protocol was written in consultation with pediatric hematologists Dr. George Dover, Dr. Ruth Luddy, Dr. Christopher Frantz, Dr. Gordon Bray/Lola Williams, P.N.P., Dr. Joseph Gootenberg, and Dr. Uy-Lee