As might reasonably be expected with splenic dysfunction, the prevalence of bacteremia in children with SCA appears to be higher. Occult bacteremia in healthy children aged 3 to 36 months in the ED setting was found to be 0.25 percent in the post-pneumococcal-conjugate-vaccine era.⁶ A retrospective study of all pediatric patients less than 18 years old with SCA at a single institution (outpatient, emergency, and inpatient) who had blood cultures drawn yielded a true bacteremia rate of 1 percent which is significantly higher.⁷ Clinically, a febrile patient with SCA should be evaluated for bacteremia via blood culture, and according to the 2014 National Heart, Lung, and Blood Institute treatment guidelines, pediatric patients with sickle cell anemia presenting with fever should receive empiric parenteral antibiotics.⁸

Summary

Splenic dysfunction appears to develop within 6 to 12 months of age in pediatric patients with sickle cell anemia and functional asplenia should be assumed in all SCA patients. In febrile children with SCA, physicians should evaluate for bacteremia via blood culture and consider empiric antibiotics.

Dr. Jones is assistant professor of pediatric emergency medicine at the University of Kentucky in Lexington.

Dr. Cantor is professor of emergency medicine and pediatrics, director of the pediatric emergency department, and medical director of the Central New York Regional Poison Control Center at Upstate Medical University in Syracuse, New York.

References

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