Wednesday, September 9, 2015

Q: All of the following are or can be parts of Acute Chest Syndrome (ACS) management except?

A) empiric antibiotic therapy

C) DVT prophylaxis
D) Exchange transfusion
E) Hemodialysis

Answer: E

Acute chest syndrome (ACS) is a life threatening complication for patients with sickle cell disease. It is defined as a new infiltrate on CXR accompanied by respiratory symptoms. Objective of above question is to highlight few important aspects of ACS which may get ignored under narrow focus of diagnosis.

As well known, IV fluid is mainstay of treatment. But, many times it is hard to distinguish or rule out community acquired pneumonia which may co-exist with ACS. Prophylactic antibiotics is recommended. Chances of DVT is very high and prophylaxis is as important as ruling out PE or existing DVT. Severe cases may require management with exchange transfusion and should kept available as backup. Hemodialysis has no role in ACS.

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