Practice Guidelines

Management of an acute painful sickle cell episode in hospital: summary of NICE guidance

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e4063 (Published 27 June 2012) Cite this as: BMJ 2012;344:e4063
  1. V L Gillis, assistant technical analyst1,
  2. A Senthinathan, technical analyst1,
  3. M Dzingina, technical analyst, health economics1,
  4. K Chamberlain, project manager1,
  5. E Banks, project manager1,
  6. M R Baker, clinical adviser1,
  7. D Longson, consultant liaison psychiatrist2
  8. on behalf of the Guideline Development Group
  1. 1National Institute for Health and Clinical Excellence, Manchester M1 4BD, UK
  2. 2Department of Psychiatry, Manchester Mental Health and Social Care Trust, Manchester M8 5RB
  1. Correspondence to: D Longson damien.longson{at}manchester.ac.uk

Sickle cell disease comprises a group of lifelong, inherited conditions of haemoglobin formation. Although the sickle gene is found in all ethnic groups, most people affected with sickle cell disease are of African or African-Caribbean origin. In the United Kingdom 12 500 to 15 000 people have sickle cell disease,1 and its prevalence is increasing because of immigration into the UK, new births, and diagnostic screening programmes.2 Acute painful sickle cell episodes (vaso-occlusive episodes) occur as a result of changes in the red blood cells that may cause tissue ischaemia and pain. These painful episodes may be triggered by factors or conditions such as dehydration, fever, or hypoxia, but can occur unpredictably, with variable intensity and frequency, and at times the pain can be excruciating. Although most episodes can be successfully managed at home, patients with uncontrolled pain may need to seek hospital care. However, the management of such episodes in hospital is thought to vary throughout the UK, and common problems include unacceptable delays in receiving analgesia, insufficient or excessive doses, inappropriate analgesia, and stigmatising the patient as drug seeking.3 4 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of an acute painful sickle cell episode in hospital.5

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

Individualised assessment of all patients with sickle cell disease presenting with acute pain

  • Treat the episode as an acute medical emergency. Follow locally agreed protocols for managing an acute painful sickle cell episode and/or an acute medical emergency that are consistent with this guideline. [Based on the experience and …

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