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Osteomyelitis in Sickle Cell Anemia
Aka: Osteomyelitis in Sickle Cell Anemia, Osteomyelitis in Thalassemia, Osteomyelitis in Hemoglobinopathy
- See Also
- Osteomyelitis
- Sickle Cell Anemia
- Transient Red Cell Aplasia
- Acute Chest Syndrome
- Acute Vaso-Occlusive Episode in Sickle Cell Anemia
- Aplastic Crisis in Sickle Cell Anemia
- Cerebrovascular Accident in Sickle Cell Anemia
- Dactylitis in Sickle Cell Anemia (Hand Foot Syndrome in Sickle Cell Anemia)
- Hematuria in Sickle Cell Anemia
- Priapism in Sickle Cell Anemia
- Pulmonary Hypertension in Sickle Cell Anemia
- Septic Arthritis in Sickle Cell Anemia
- Sickle Cell Anemia Related Pulmonary Hypertension
- Sickle Cell Anemia with Splenic Sequestration
- Pathophysiology
- Infection of infarcted bone, especially long bones (multiple sites in same bone may be involved)
- Causes
- Salmonella
- Most common organism in Sickle Cell AnemiaOsteomyelitis
- Other Gram Negative Bacteria may also occur
- Staphylococcal Aureus (<25% of cases)
- Signs
- Fever
- Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
- Extremity swelling
- Osteomyelitis likelihood increases 8.4 fold
- Bone pain
- Osteomyelitis likelihood increases 20% each day of pain
- Diagnosis
- Bone Culture
- Labs
- Blood Cultures
- Test Sensitivity: 30 to 76%
- Imaging
- See Osteomyelitis
- Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis
- Management
- See Osteomyelitis
- Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
- Total antibiotic course: 6 to 8 weeks
- Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
- Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes
- References
- Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
- Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23