I asked our sickle cell specialist, Louis Hsu (Emory), to comment on Jay
Pershad's question and Jay Fisher's response. Below are the original
questions along with his response.
Jeff Linzer MD MICP
Division of Emergency Medicine
Egleston and Hughes Spalding Children's Hospitals
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---------- Forwarded message ----------
>I was wondering if folks could share their experience/data on reliability
>of ESR in this setting to rule out a pyogenic effusion.
----------> ESR is not reliable in sickle cell disease, can easily be
falsely low due to the abnormal shape of the sickle RBC (makes rouleaux
formation difficult, and therefore sedimentation rate may always be slow)
>Also, would you tap this elbow for analysis of the fluid?
------> with fever & first occurence, yes. It may also give some
symptomatic relief. Avoid general anesthesia if possible due to the high
rate of complications in sickle cell patients.
>Is a sympathetic effusion from an acute vasoocclusive crisis a common
------> yes, we see this several times per year in our population of 400
sickle cell children.
>A combination of a marrow scan with technetium sulfur colloid
>and a technetium bone scan have fairly good diagnostic accuracy
>in children in which you have a lower suspicion
>(Rao et al. J Pediatr 1985:107:685-688).
------------> we (Emory) have had very poor predictive value with Tc sulfur
colloid scan or bone scan in distinguishing sickle vaso-occlusion from
infection. Not sure whether this reference means simultaneous scans.
>I know of one small study in which sed rates in this population
>had a sensitivity of about 80% of cases of bone or joint infection.
>(Syrogiannopoulos et al.Pediatrics 1986;78:1090-1096).
---------> prefer CRP. However, sickle vaso-occlusion can be also
associated with elevated CRP as well as numerous inflammatory markers
(IL-1, IL-8, D-dimers, activated WBC, activated endothelium)
[sorry Jeff, but I did not have time to get literature references
to bolster clinical experience]
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