Hematology and Oncology Book

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Septic Arthritis in Sickle Cell Anemia

Aka: Septic Arthritis in Sickle Cell Anemia, Septic Joint in Sickle Cell Anemia
  1. See Also
    1. Septic Arthritis
    2. Sickle Cell Anemia
    3. Osteomyelitis in Sickle Cell Anemia
    4. Transient Red Cell Aplasia
    5. Acute Chest Syndrome
    6. Acute Vaso-Occlusive Episode in Sickle Cell Anemia
    7. Aplastic Crisis in Sickle Cell Anemia
    8. Cerebrovascular Accident in Sickle Cell Anemia
    9. Dactylitis in Sickle Cell Anemia (Hand Foot Syndrome in Sickle Cell Anemia)
    10. Hematuria in Sickle Cell Anemia
    11. Priapism in Sickle Cell Anemia
    12. Pulmonary Hypertension in Sickle Cell Anemia
    13. Sickle Cell Anemia Related Pulmonary Hypertension
    14. Sickle Cell Anemia with Splenic Sequestration
  2. Causes
    1. Staphylococcus aureus (most common cause)
    2. Streptococcus Pneumoniae
    3. Salmonella
  3. Labs
    1. Synovial Fluid (obtain in all suspected cases)
      1. Normal Synovial Fluid cell count in >50% of Septic Arthritis cases
      2. Gram Stain Test Sensitivity is only 50% (high False Negative Rate)
      3. Synovial Fluid is the gold standard for diagnosis
  4. Management
    1. Obtain Synovial Fluid culture and start empiric antibiotics
    2. Total antibiotic course: 6 weeks
    3. Initial empiric management
      1. Cephaloporin sensitive
        1. Ceftriaxone 50-75 mg/kg up to 2 g/dose OR
        2. Ceftriaxone 75-100 mg/kg in high S. Pneumoniae resistance regions
      2. Cephalosporin resistance
        1. Clindamycin 10-15 mg/kg/dose (preferred) OR
        2. Vancomycin 15 mg/kg/dose (if systemic Sepsis or Clindamycin reactions)
  5. References
    1. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23

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