Approaches to Disease Management – Sickle Cell Anemia
Sickle cell anemia is a blood condition that is inherited. It is characterized by a lack of adequate healthy RBCs to supply enough oxygen across the body. While a healthy individual has round, donut-shaped RBCs, the RBCs of an individual affected by sickle cell anemia are crescent or sickle-shaped. The condition is usually associated with pain and jaundice, and it can only result from both parents passing down the sickle cell gene to their children. Although nearly two million people in the U.S. carry the sickle cell gene, most of them do not have it. However, if two individuals having the gene marry, there is a 25% likelihood their offspring can end up having the condition. Piel, Steinberg, & Rees (2017) indicate that the gene is frequent in people of Indian, Mediterranean, Spanish, and African origin. In a newborn baby, sickle cell anemia can be diagnosed by sampling some amniotic fluid to check for the presence of the sickle cell gene. This test is part of routine newborn screening in the United States.
The case presented is of a 2-month-old child diagnosed with sickle cell anemia during newborn screening. According to Rattler et al. (2016), management of the condition often aims to relieve symptoms, avoid complications, and prevent pain episodes. Treatment options may include blood transfusions and medications. Besides, a stem cell transplant may cure the condition in some kids. For the 2-month-old child, penicillin 125 mg daily would be prescribed to help in preventing severe infections. The provider would advise the parents to keep the medication in the refrigerator, and a refill would only be done at the pharmacy every ten days. Acetaminophen and folic acid would also be prescribed to relieve pain and help the body make healthy RBCs. The provider also needs to ensure that the child is up-to-date with all the necessary vaccinations.
As the child grows through to age 2 and 6 years old, the spleen’s sequestration would continuously be checked, and the pain that may accompany it assessed. At age 2, healthy practices would be introduced into the daily life of the child. The child would need to begin taking plenty of fluids to help in preventing dehydration. It would also be necessary for the child to start eating a balanced diet. When the child hits six years old, it would be appropriate to initiate routine physical activity to ensure that the child stays active. The parents would be advised to ensure that the child does not get overly dehydrated or tired or work too hard. By age 13, the child would have had the spleen removed or lasting damages from repeated splenic sequestration. Thus, the risk of infection is a significant concern (Bates et al., 2020). As such, the focus would be on the prevention of infectious diseases through proper household hygiene.
The child living with sickle cell anemia may feel anxious about having repeated and sudden episodes of pain. The child, particularly in teens, may also experience difficult times with the condition as it may delay puberty. In this case, the medical provider would refer the child to the Sickle Cell Disease Association of America, Inc. (SCDAA). The organization stages several high-profile events and works at the community level to focus on sickle cell anemia and the people living with it. The organization will be helpful to the child in learning approaches to coping with the situation.
References
Bates, K. E., Davis, C. S., Reeves, S. L., & Freed, G. L. (2020). Designing a Multistakeholder Collaboration to Improve Preventive Care for Children With Sickle Cell Anemia. Journal of Pediatric Hematology/Oncology, 42(3), e152-e158. DOI: https://doi.org/10.1097/MPH.0000000000001666
Piel, F. B., Steinberg, M. H., & Rees, D. C. (2017). Sickle cell disease. New England Journal of Medicine, 376(16), 1561-1573. DOI: 10.1056/NEJMra1510865
Rattler, T. L., Walder, A. M., Feng, H., & Raphael, J. L. (2016). Care coordination for children with sickle cell disease: A Longitudinal Study of Parent Perspectives and Acute Care Utilization. American Journal of Preventive Medicine, 51(1), S55-S61. https://doi.org/10.1016/j.amepre.2016.01.023
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Question 
A 2-month-old is identified during newborn screening with sickle cell anemia.
How would you manage this patient at 2 months, 2 years, 6 years, and 13 years old?
Approaches to Disease Management
What are the issues for each stage in development?
Where would you refer this child?
How would you coordinate the care of this child?
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The post should be at least 500 words, formatted and cited in the current APA style, with support from at least 2 academic sources.