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The hematology group here at St Judes believes that  sickle cell patient that
has low risk parameters for sepsis can be managed as an outpatient.
 
The parameters are:
age > 6months, <16 years
WBC < 20,000 > 5,000
ANC > 1500
Retic count > 1.0
No prior history of pneumococcal spesis
must have a phone and a ride
stable hematocrit
Temp < 40.0 C
must not look toxic.
 
so we get CBC, retic count,U/A, UCX and CXR on all febrile patients with SS
disease. If they are > 6 month or < 16 years old ,
we start an IV and give ceftriaxone 50 mg/Kg, They are observed for 8 hours in
the ED or OBS unit if the lab work is all within the low risk parameters.
Of course the CXR also must be clear. They are sent home on ceftriaxone
50mg/kg /day and scheduled to see the hemotology docs the following day. A
heme nurse calls the family for followup in th AM. Now if the temp is over 40
or any of the labs exceed the parameters, the patient is admitted. If they
have had a prior episode of sepsis, especially with pneumococus, we start
Vancomycin .
 
For a reference see Wilamas JA, FLynn PM, Harris S, et al. A randomized study
of outpatient treatment with ceftriaxone for selected febrile children with
sickle cell disease. N Eng J Med 329: 472-476, 1993.
 
 
 
 
About 1 in 20 patients fail the observtion period and have to be admitted. Of
course we prefer to err onthe side of being conservative when the social
situation is questionable.
 
 
Regards,
 
MIH
Memphis
 
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