Category — Blood Transfusion

September 10, 2005

Dear Emergency Department Physician Director,

Treatment of Minnesota patients with sickle cell disease has been refined in recent years, resulting in improved patient outcomes and fewer emergency room visits. However, because of the nature of sickle cell disease, affected patients will continue to present to emergency rooms for evaluation of new symptoms and pain management. These patients are at risk for life-threatening complications; therefore, rapid triage and recognition of symptoms is needed to decrease morbidity and mortality from sickle cell disease.

The Minnesota Department of Health (MDH), in collaboration with medical specialists and care providers of the Minnesota Hemoglobinopathy Collaborative (MNHC), developed the enclosed “Minnesota Sickle Cell Disease Emergency Guidelines.” MNHC is a voluntary group formed to address issues that concern Minnesota providers and patients who are affected by hemoglobinopathies. MDH and MNHC created the two-page guideline tool to help emergency room care providers establish protocols that effectively assess, triage, and initiate treatment of patients with sickle cell disease.

September is Sickle Cell Disease Awareness Month. MNHC elected to address concerns about emergency care of patients with sickle cell disease by developing guidelines to serve as the cornerstone for discussion and education. After reviewing existing guidelines, tools, and patient and professional experiences, MDH and MNHC concluded that the Minnesota guidelines must be concise, presented in a checklist format, and directed at emergency care providers. The Minnesota guidelines were adapted from existing documents created by entities such as the National Institutes of Health; Grady Hospital in Atlanta, GA; Sickle Cell Disease Care Consortium, MSRGN; and Critical Elements of Care in Seattle, WA. The enclosed guidelines provide the minimum considerations necessary to evaluate and treat all patients with sickle cell disease and do not address the status of specific patients. For individual patient management, MNHC also endorses the use of individualized care plans and tools such as the Emergency Information Form available from the American Academy of Pediatrics and the College of Emergency Physicians: http://www.aap.org/advocacy/emergprep.htm

MDH and MNHC developed three overarching principles to summarize the important issues in emergency care of patients with sickle cell disease. The principles include: (1) All patients with sickle cell disease should be treated according to accepted standards of care for sickle cell disease in consultation with a hematologist knowledgeable in sickle cell disease. (2) All patients with sickle cell disease presenting to emergency departments with symptoms of a sickle crisis should be assigned high priority for assessment and treatment because of risk for severe, life-threatening complications. (3) Emergency room discharge planning should include consideration of factors that may impact the patient’s post-discharge medical course. Certain patients may require emergent social services intervention or referral. When emergency room staff is concerned about the patient’s ability to accomplish adequate post-discharge care, consider consulting the patient’s primary care physician or specialty care provider.

MDH and MNHC appreciate your attention to the concerns of patients with sickle cell disease. Please contact the MDH Newborn Screening Program (800-664-7772) if you have any questions or concerns about the enclosed guidelines. A press release, copy of the guidelines, and this letter can be found on the MDH website at http://www.health.state.mn.us/divs/fh/mcshn/nbsprov.htm

Sincerely,