2024, Number 9
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Med Int Mex 2024; 40 (9)
Sickle cell disease in emergency department: An evidence-based review
Duque EL, Saavedra VME, Vergara YD, Martínez-Sánchez LM
Language: Spanish
References: 58
Page: 581-590
PDF size: 358.00 Kb.
ABSTRACT
Sickle cell disease is an autosomal recessive hematological disorder caused by an
amino acid substitution in the beta-globin chain of adult hemoglobin. This substitution
produces polymerization of hemoglobin resulting in sickle-shaped red blood cells,
this process in addition to generating rigid erythrocytes initiates a series of events that
include changes in the function of the erythrocyte membrane, uniform distribution
of erythrocyte volume, alterations in endothelial activity and increased adherence to
the vascular endothelium, uniform distribution of erythrocyte volume, alterations in
endothelial activity and increased adherence to the vascular endothelium, causing
complications such as vaso-occlusive crises, pulmonary hypertension, chronic pain,
ischemic complications, anemia, pneumococcal infections and acute chest syndrome.
Clinically the disease is characterized by hemolytic anemia, which progressively occludes
different organs, with vaso-occlusive crises and pain. Pain is the most frequent
symptom and the one that generates most costs to the health system, due to emergency
department visits and number of hospitalizations. These pain crises are of variable duration
and can occur at different sites of the body, but most often in bones like the spine,
lower extremities in adults and dactylitis in infants or newborns. The global treatment
for sickle cell disease is based on the use of hydroxyurea, red blood cell transfusion,
erythroapheresis, stem cell transplantation in selected patients and recently glutamine
has appeared as a new choice.
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