Urgent Investigation of Suspected Painful Sickle Cell Crisis
Full blood count, blood film, reticulocyte count* Confirmatory diagnosis (high pressure liquid chromatography) if patient not known to have sickle cell disease or new to hospital† Transfusion compatibility testing (group and screen) if the patient new to hospital or if severely unwell and transfusion may be indicated Blood culture, urine microscopy and culture and viral screening if patient febrile Chest X-ray if patient febrile or hypoxic Arterial blood gases (if oxygen saturation <95%, chest X-ray shadowing or respiratory symptoms) Electrolytes and creatinine Liver function tests C-reactive protein |
* Blood film in sickle cell disease (homozygous SS): normochromic normocytic anaemia; raised reticulocyte count; Howell-Jolly bodies (reflecting hyposplenism) in adults, usually sickle cells. Numerous target cells may indicate HbSC.
† Solubility test indicates the presence of HbS, and is therefore positive in both homozygotes (SS) and heterozygotes (AS, sickle cell trait) and also in compound heterozygotes (S Beta thalassaemia, HbSC).