RCP Medicine Podcast Episode 87: Sickle cell
Jul 18, 2025
Dr Dale Seviar, consultant haematologist at Guy's and St Thomas' with expertise in haemoglobinopathies, guides a clinical stroll through sickle cell care. Short, practical segments cover initial assessment, acute pain management, acute chest syndrome differentials and transfusion complications. The conversation closes with long term treatments, curative options and on-call tips for timely escalation.
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Treat Pain Fast And Reassess
- Give analgesia within 30 minutes and follow the patient's pain plan or WHO ladder for severe pain.
- Reassess after 30 minutes and admit if more than three bolus opioid doses are needed.
Use ACT NOW As A Practical Checklist
- Use the ACT NOW mnemonic: Analgesia, Compassion, Test/Trigger, Notify, Oxygen, Watch.
- Include adjuncts (antiemetics, laxatives, naloxone PRN) and involve haematology early if NEWS ≥4 or SpO2 <96% on air.
Why Red Cells Sickled And Hemolyse
- Sickle cell arises from a beta-globin amino acid substitution that makes haemoglobin hydrophobic and polymerize when deoxygenated.
- The disease combines vaso-occlusion and hemolysis, shortening red cell survival from 120 to about 14 days.