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Priapism in Sickle Cell Anemia
Aka: Priapism in Sickle Cell Anemia
- See Also
- Sickle Cell Anemia
- Priapism
- 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
- Osteomyelitis 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
- Epidemiology
- Incidence of Priapism in Sickle Cell Anemia: 89% by age 20 years old
- Management
- Duration: <2 hours
- Analgesics
- IV Fluids
- Do not transfuse for Priapism <4 hours
- Duration: 2-4 hours
- First
- Intracavernosal Epinephrine (1:1,000,000 dilution) or Phenylephrine injection
- Other measures
- Nifedipine 10 mg (in repeated doses)
- Duration >4 hours
- Administer above measures if not already attempted
- Exchange transfusion (Risk of CVA symptoms)
- Epidural Anesthesia
- Urology Consultation indications
- Priapism refractory to medical management >4-6 hours
- Corpora spongiosa and cavernosa Shunt (Priapism >24 hours)
- Placed through glans penis
- Often effective (may need repeat)
- Does not interfere with subsequent Erection
- Discharge criteria
- Priapism resolves and no recurrence during observation in ED
- Prevention
- Nitroglycerin patch (0.2 - 0.4 mg/hour)
- Applied at bedtime may prevent nighttime attacks
- Course
- Resolves spontaneously
- May occur frequently
- Complications
- Repeated Priapism results in
- Thickening and gross enlargement of the penis
- Penis may remain semi-erect
- Impotence
- Penile Implants
- References
- Glassberg and Weingart in Majoewsky (2012) EM: Rap 12(9): 4
- Yawn (2015) Am Fam Physician 92(12): 1069-76 [PubMed]