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SICKLE CELL ANEMIA

Sickle Cell Anemia

Belinda Stevens

ECPI

NUR 207

January 17, 2007

Sickle cell anemia is an inherited blood disorder that mostly affects people of African

ancestry. It also occurs in other ethnic groups including people who are of Mediterranean and

Middle Eastern descent. 250,000 children with sickle cell disease are born each year worldwide.

Sickle cell anemia occurs when a person inherits two abnormal genes, one from each parent, that

cause their red blood cells to change shape. Instead of being flexible and disc-shaped, the cells

are more stiff and curve-shaped. All types of sickle cell disease are caused by a genetic change

in hemoglobin, the oxygen-carrying protein inside the red blood cells. Due to the genetic

change, an abnormal form of hemoglobin, hemoglobin S, is produced. Red blood cells with

normal hemoglobin move easily through the bloodstream delivering oxygen to all of

the cells of the body. Hemoglobin S molecules tend to clump together; and, instead of moving

through the bloodstream easily, they can clog blood vessels causing anoxia. Anoxia is a

condition where the body’s tissues and organs are deprived of oxygen. Lack of oxygen may also

cause necrosis to the tissues supplied. The lifespan of a red blood cell is decreased from a normal

120 days to 10-12 days in most patients with sickle cell disease”.

People with sickle cell anemia may develop jaundice which is a condition that results

from the high rate of red blood cell breakdown. Jaundice can cause the skin and the whites of a

person's eyes to develop a yellowish tint. Patients who suffer from sickle cell anemia may

experience severe pain which is caused by the blockage of tiny blood vessels due to the sickle-

shape of the red blood cells. These periods of pain, called crises, may be rare or can occur up to

a dozen or more times a year. The pain may be experienced in the patient’s thoracic and

abdominal areas as well as in bones. The pain may be short term or last for several weeks and

can vary from mild to very intense.

Red blood cells provide the body with all the essential nutrients needed for growth.

With a shortage of healthy red blood cells, infants and children with sickle cell may have delayed
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growth and may reach puberty at a much later age than normal. By early adulthood, they catch

up on growth and attain normal height; however, weight typically remains below average.

Individuals with sickle cell are also at risk for having a stroke due to a blocked blood vessel or

by the hemorrhage of a blood vessel in the brain.

Acute chest syndrome is a life threatening complication among people who have sickle

cell anemia. Acute chest syndrome is similar to pneumonia, but is caused by a lung infection or

trapped sickle cells in the blood vessels of your lungs. People affected by acute chest syndrome

may experience severe cough, fever, chest pain, and shortness of breath. The tiny blood vessels

that supply oxygen to eyes can get blocked with sickle cells leading to a condition caused

retinopathy. Over time, damage to the retina can lead to blindness.

There is no cure for sickle cell anemia. It is possible for some people to be ill enough to

die from the disease. Doctors can provide treatments that help prevent complications from the

disease such as Folic acid, Pain medication, antibiotics and hydroxyurea.

Folic acid is a vitamin that helps the body produce new red blood cells. Pain medications

help relieve the symptoms of crises and children who have sickle cell disease should take

penicillin or other antibiotics to help prevent infections. Hydroxyurea, a drug that was originally

designed for the treatment of cancer, has been beneficial to people with sickle cell anemia. It has

been shown to reduce the frequency of painful crises. It seems to work by stimulation the

production of fetal hemoglobin—a type of hemoglobin found in newborns that helps prevent the

formation of sickle cells The major side effects of this drug include decreased production of

platelets, red blood cells, and certain white blood cells.

Blood transfusions are sometimes given to patients with frequent and severe painful

crises. The blood transfusions increase the number of normal red blood cells helping to relieve

anemia. Those at high risk of stroke often receive transfusions to decrease the risk. However,
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there are risks with regular blood transfusions such as an excess build up of iron in the body

causing damage to various tissues and organs.

In some cases, bone marrow transplants have shown to be a treatment for sickle cell

anemia. The procedure allows the person with sickle cell anemia to replace diseased bone

marrow with healthy bone marrow from a donor who does not have sickle cell. It is very difficult

to find a suitable donor, and the procedure is risky. Bone marrow transplants have shown to be

more effective in children than adults.

Inheritance of sickle cell anemia cannot be prevented or cured; however, with today’s

medical advances, people with sickle cell disease are living longer and healthier lives. People

who are in high risk populations should be screened so that appropriate medical decisions can be

made. Staying healthy is critical for people with sickle cell anemia. Eating well and getting an

adequate amount of rest is a good way to prevent the onset of a pain crisis. Infants and children

with sickle cell anemia should get regular vaccinations to prevent infections. It is suggested that

anyone with sickle cell drink plenty of water and avoid extreme temperatures. Regular exercise

is healthy, but it should not be overdone. People with sickle cell should also take folic acid

supplements as well as other vitamins to make new, healthy red blood cells.

Nursing care for Sickle Cell crisis in hospital setting is supportive and symptomatic.

Patient is confined to bed. Analgesics are given for pain. Continuous IV infusion may be given

for severe pain. An accurate record of intake and output is kept. The patient’s body position is

changed frequently but gently. Nurse should recognize that with children pain can be

indistinguishable between abdominal pain with a crisis or abdominal pain related to appendicitis.

The nurse should also remember that with children pain could be caused by an unrelated

condition. Prevention of infection and prevention of dehydration are important with this disease.

The nurse should also recognize any reaction to blood transfusion if given.
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References

Bojanowski, J., MS, CGC, & Frey, R. (2004). Sickle Cell Disease. Retrieved February 20,
2009,

from.

http://www.jiffynotes.com/a_study_guides/book_notes_add/gem_0003_0004_0/gem_0003_0004

_0_01489.html

Mayo Clinic Staff. (March 28, 2007). Sickle Cell Anemia. Retrieved July 8, 2007. from

http://www.mayoclinic.com/health/sickle-cell-anemia/DS00324

Pellegrino, A, (2007). Sickle Cell Disease. Retrieved February 20, 2009,

http://www.uspharmacist.com/content/t/hematology/c/10177/