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What is the management of suspected osteomyelitis in Sickle Cell Disease?
The management of suspected osteomyelitis in SCD is outlined in the below table
Management of Suspected Osteomyelitis in Sickle Cell Disease
| 1. Admit patient to hospital for thorough evaluation. |
| 2. Immobilize affected bones to avoid pathologic fracture. |
| 3. Check baseline complete blood count, erythrocyte sedimentation rate, and C-reactive protein. |
| 4. Consult hematology and infectious disease services. |
| 5. Obtain blood cultures. |
| 6. Consider serologic tests and stool cultures for Salmonella. |
| 7. Obtain plain radiographs of all involved bones; repeat these in 10 to 14 days if the originals are normal. |
| 8. Consider magnetic resonance imaging of affected area. Obtain a radionuclide bone or gallium scan. |
| 9. Aspirate for culture any joints and/or bones that are suspected for infection. |
| 10. After a diagnosis is established, preoperative measures are instituted to decrease the risk of surgical complications (transfusions to achieve hemoglobin A level 60% of total hemoglobin, maintenance of adequate oxygenation and hydration). |
| 11. All abscesses in bones should be promptly decompressed to restore blood supply. |
| 12. Avoid tourniquets for intraoperative hemostasis. |
| 13. Do not start antibiotics until adequate specimens of blood, bone, and pus are obtained for culture and Gram stain. |
| 14. Initiate antibiotics based on Gram stain results, considering the possibility of Salmonella. |
| 15. Parenteral antibiotics are continued for up to 6 to 8 weeks. |
