Vaso-occlusive pain crisis - Revision history

Benalexander: Clean up duplicated references.

2025-10-31T20:25:26Z

Clean up duplicated references.

← Revisión anterior		Revisión del 20:25 31 oct 2025
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	==Background==		==Background==
	*Common complication of [[sickle cell anemia]], constituting 79-91% of ED visits<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>		*Common complication of [[sickle cell anemia]], constituting 79-91% of ED visits<ref name="Lovett">Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>
	*Sickled red blood cells obstruct vasculature, causing ischemic injury and pain		*Sickled red blood cells obstruct vasculature, causing ischemic injury and pain
	*Provider misconceptions can interfere with adequate pain assessment and can lead to insufficient treatment. Avoid use of the terms "sickler" or "frequent flier." Early, adequate, and aggressive pain treatment is essential. <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease~~?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569~~</ref>		*Provider misconceptions can interfere with adequate pain assessment and can lead to insufficient treatment. Avoid use of the terms "sickler" or "frequent flier." Early, adequate, and aggressive pain treatment is essential. <ref name="uptodate">DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease-children-and-adults</ref>

	===Precipitating Factors===		===Precipitating Factors===
Línea 15:		Línea 15:
	*Exertional stress		*Exertional stress

	==Clinical Features<ref>Lovett ~~P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47<~~/~~ref~~> <ref~~>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.~~uptodate~~.com~~/~~contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref~~>==		==Clinical Features<ref name="Lovett" /> <ref name="uptodate" />==
	*Pain		*Pain
	**Upper and lower [[back pain\|back]], long bones most commonly affected		**Upper and lower [[back pain\|back]], long bones most commonly affected
Línea 40:		Línea 40:
	==Management==		==Management==
	*[[Analgesia]]		*[[Analgesia]]
	**Pain assessment comes from the patient or patient family. No lab or clinical findings determine, confirm, or change if a patient has pain. Absence of hemolysis or baseline hemoglobin level should not be used to withhold or decrease pain medication dosing. <ref~~>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.~~uptodate~~.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569<~~/~~ref~~>		**Pain assessment comes from the patient or patient family. No lab or clinical findings determine, confirm, or change if a patient has pain. Absence of hemolysis or baseline hemoglobin level should not be used to withhold or decrease pain medication dosing. <ref name="uptodate" />
	**Ask the patient what medications have worked for them in the past		**Ask the patient what medications have worked for them in the past
	**Pain medication should be dosed within 30 minutes, IV route preferred with SC or IN routes for those with access issues <ref~~>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.~~uptodate~~.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569<~~/~~ref~~>		**Pain medication should be dosed within 30 minutes, IV route preferred with SC or IN routes for those with access issues <ref name="uptodate" />
	**IV [[opioids]] ([[morphine]] or [[hydromorphone]])		**IV [[opioids]] ([[morphine]] or [[hydromorphone]])
	***Redose in 30min if inadequate		***Redose in 30min if inadequate
	***Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. <ref~~>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.~~uptodate~~.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569<~~/~~ref~~>		***Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. <ref name="uptodate" />
	**Non-opioid analgesia		**Non-opioid analgesia
	***[[NSAIDs]] (e.g. [[ketorolac]] 15mg q6h)		***[[NSAIDs]] (e.g. [[ketorolac]] 15mg q6h)
	***[[Acetaminophen]]		***[[Acetaminophen]]
	**IV/IM [[haloperidol]] or [[droperidol]] 5-10mg<ref>Lyness, D., & Motov, S. (2016, July 7). CERTA Opioid Alternatives and Analgesics. Retrieved July 25, 2016, from http://www.propofology.com/infographs/certa-opioid-alternatives-as-analgesics</ref>		***IV/IM [[haloperidol]] or [[droperidol]] 5-10mg<ref name="Lyness">Lyness, D., & Motov, S. (2016, July 7). CERTA Opioid Alternatives and Analgesics. Retrieved July 25, 2016, from http://www.propofology.com/infographs/certa-opioid-alternatives-as-analgesics</ref>
	**[[Ketamine]] (IN 1mg/kg 1ml per nostril or IV 0.3mg/kg)<ref>Lyness~~, D., & Motov, S. (2016, July 7). CERTA Opioid Alternatives and Analgesics. Retrieved July 25, 2016, from http://www.propofology.com/infographs/certa-opioid-alternatives-as-analgesics<~~/~~ref~~>		***[[Ketamine]] (IN 1mg/kg 1ml per nostril or IV 0.3mg/kg)<ref name="Lyness" />
	**Nonpharmacologic measures (e.g. heating packs, distraction)		**Nonpharmacologic measures (e.g. heating packs, distraction)
	*Hydration		*Hydration
Línea 65:		Línea 65:
	**[[splenic sequestration\|Sequestration crisis]]		**[[splenic sequestration\|Sequestration crisis]]
	**hemoglobin <6 with inappropriately low retic count		**hemoglobin <6 with inappropriately low retic count
	**Transfusion is not a treatment for vast-occlusive pain without anemia <ref~~>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.~~uptodate~~.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569<~~/~~ref~~>		**Transfusion is not a treatment for vast-occlusive pain without anemia <ref name="uptodate" />

	===Pediatric Pain Crisis===		===Pediatric Pain Crisis===

SMReel: /* Clinical FeaturesLovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47 and DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://w...

2022-04-20T15:37:29Z

/* Clinical FeaturesLovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47 and DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://w...

← Revisión anterior		Revisión del 15:37 20 abr 2022
Línea 15:		Línea 15:
	*Exertional stress		*Exertional stress

	==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref> ~~and~~ <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>==		==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref> <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>==
	*Pain		*Pain
	**Upper and lower [[back pain\|back]], long bones most commonly affected		**Upper and lower [[back pain\|back]], long bones most commonly affected

SMReel: /* Clinical FeaturesLovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47 */

2022-04-20T15:36:21Z

Clinical FeaturesLovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47

← Revisión anterior		Revisión del 15:36 20 abr 2022
Línea 15:		Línea 15:
	*Exertional stress		*Exertional stress

	==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>==		==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref> and <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>==
	*Pain		*Pain
	**~~Lower~~ [[back pain\|back]], long bones most commonly affected		**Upper and lower [[back pain\|back]], long bones most commonly affected
			**Can also include abdomen, chest, arms
			**Often multiple sites are involved
			**Intensity can be debilitating and pain can last from hours to days with some individuals never being completely without pain

	==Differential Diagnosis==		==Differential Diagnosis==

SMReel: /* Management */

2022-04-20T15:31:27Z

Management

← Revisión anterior		Revisión del 15:31 20 abr 2022
Línea 37:		Línea 37:
	==Management==		==Management==
	*[[Analgesia]]		*[[Analgesia]]
			**Pain assessment comes from the patient or patient family. No lab or clinical findings determine, confirm, or change if a patient has pain. Absence of hemolysis or baseline hemoglobin level should not be used to withhold or decrease pain medication dosing. <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>
			**Ask the patient what medications have worked for them in the past
			**Pain medication should be dosed within 30 minutes, IV route preferred with SC or IN routes for those with access issues <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>
	**IV [[opioids]] ([[morphine]] or [[hydromorphone]])		**IV [[opioids]] ([[morphine]] or [[hydromorphone]])
	***Redose in 30min if inadequate		***Redose in 30min if inadequate
			***Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>
	**Non-opioid analgesia		**Non-opioid analgesia
	***[[NSAIDs]] (e.g. [[ketorolac]] 15mg q6h)		***[[NSAIDs]] (e.g. [[ketorolac]] 15mg q6h)
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	**[[splenic sequestration\|Sequestration crisis]]		**[[splenic sequestration\|Sequestration crisis]]
	**hemoglobin <6 with inappropriately low retic count		**hemoglobin <6 with inappropriately low retic count
			**Transfusion is not a treatment for vast-occlusive pain without anemia <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>

	===Pediatric Pain Crisis===		===Pediatric Pain Crisis===

SMReel: /* Background */

2022-04-20T15:06:30Z

Background

← Revisión anterior		Revisión del 15:06 20 abr 2022
Línea 2:		Línea 2:
	*Common complication of [[sickle cell anemia]], constituting 79-91% of ED visits<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>		*Common complication of [[sickle cell anemia]], constituting 79-91% of ED visits<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>
	*Sickled red blood cells obstruct vasculature, causing ischemic injury and pain		*Sickled red blood cells obstruct vasculature, causing ischemic injury and pain
			*Provider misconceptions can interfere with adequate pain assessment and can lead to insufficient treatment. Avoid use of the terms "sickler" or "frequent flier." Early, adequate, and aggressive pain treatment is essential. <ref>DeBaun, M. Acute vaso-occlusive pain management in sickle cell disease. UpToDate. 2022 Mar. Accessed via: https://www.uptodate.com/contents/acute-vaso-occlusive-pain-management-in-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=14519&source=see_link#H317569</ref>

	===Precipitating Factors===		===Precipitating Factors===

Shihabali: /* Management */

2019-11-27T01:24:26Z

Management

@@ Línea 57: / Línea 57: @@
 **[[splenic sequestration|Sequestration crisis]]
 **hemoglobin <6 with inappropriately low retic count
 ==Disposition==

ClaireLewis at 19:11, 1 October 2019

2019-10-01T19:11:32Z

← Revisión anterior		Revisión del 19:11 1 oct 2019
Línea 1:		Línea 1:
	==Background==		==Background==
			*Common complication of [[sickle cell anemia]], constituting 79-91% of ED visits<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>
			*Sickled red blood cells obstruct vasculature, causing ischemic injury and pain

	===Precipitating Factors===		===Precipitating Factors===
	*Stress		*Stress
	*Cold weather		*Cold weather
	*Dehydration		*[[Dehydration]]
	*Hypoxia		*[[Hypoxia]]
	*Infection		*[[Infection]]
	*Acidosis		*[[Acidosis]]
	*Alcohol intoxication		*[[Alcohol intoxication]]
	*Pregnancy		*[[Pregnancy]]
	*Exertional stress		*Exertional stress

	==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>==		==Clinical Features<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>==
	*Pain		*Pain
	**Most common manifestation of SCA (79-91% of ED visits)		**Lower [[back pain\|back]], long bones most commonly affected
	**Lower back, long bones most commonly affected

	==Differential Diagnosis==		==Differential Diagnosis==
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	*CBC		*CBC
	**Because anemia can precipitate a crisis, must check for acute hemoglobin drop		**Because anemia can precipitate a crisis, must check for acute hemoglobin drop
	*Chemistry / LFT / lipase
	**If abdominal pain, may be cholecystitis, mesenteric ischemia, or perforation
	*Retic count (if aplastic crisis considered - rare in adults)		*Retic count (if aplastic crisis considered - rare in adults)
	**Should be >0.5%		**Should be >0.5%
	*T&S/T&C		*Consider:
	*Urine pregnancy		**Chemistry / [[LFTs]] / lipase
	*[[CXR]]		***If abdominal pain, may be cholecystitis, mesenteric ischemia, or perforation
	**If cough, shortness of breath, or febrile		**T&S/T&C
			**Urine pregnancy
			**[[CXR]]
			***If cough, shortness of breath, or febrile

	==Management==		==Management==
Línea 48:		Línea 51:
	*O2 if [[hypoxia]]; otherwise may inhibit erythropoiesis		*O2 if [[hypoxia]]; otherwise may inhibit erythropoiesis

	===Anemia===		===[[Anemia]]===
	*Transfusion [[PRBCs]] 10 mL/kg over 2hr period		*Transfusion [[PRBCs]] 10 mL/kg over 2hr period
	*Indications:		*Indications:
	**[[Aplastic crisis]]		**[[Aplastic crisis]]
	**Sequestration crisis		**[[splenic sequestration\|Sequestration crisis]]
	**hemoglobin <6 with inappropriately low retic count		**hemoglobin <6 with inappropriately low retic count

Línea 60:		Línea 63:
	*[[Sepsis]], [[osteomyelitis]], or other serious infection is suspected		*[[Sepsis]], [[osteomyelitis]], or other serious infection is suspected
	*[[Priapism]], [[aplastic crisis]], [[hypoxia]], splenic sequestration		*[[Priapism]], [[aplastic crisis]], [[hypoxia]], splenic sequestration
	*WBC >30K		*[[leukocytosis\|WBC >30K]]
	*~~Platlet~~ <100K		*[[thrombocytopenia\|Platelet <100K]]
	*Pain is not under control after 3 rounds of analgesics in ED		*Pain is not under control after 3 rounds of analgesics in ED
	*<1yr old		*<1yr old

ClaireLewis: /* Management */

2019-09-24T04:03:58Z

Management

← Revisión anterior		Revisión del 04:03 24 sep 2019
Línea 46:		Línea 46:
	***[[IVF]] bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling. <ref> Glassberg, J., Evidence-based management of sickle cell disease in the emergency department.Emerg Med Pract, 2011. 13(8): p. 1-20</ref> <ref> Carden, M.A., et al., Variations in pediatric emergency medicine physician practices for intravenous fluid management in children with sickle cell disease and vaso-occlusive pain: A single institution experience.Pediatr Blood Cancer, 2018. 65(1) </ref> <ref> Carden, M.A., et al., Normal Saline Bolus Use in Pediatric Emergency Departments is Associated with Worse Pain Control in Children with Sickle Cell Anemia and Vaso-occlusive Pain.Am J Hematol, 2019. </ref>		***[[IVF]] bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling. <ref> Glassberg, J., Evidence-based management of sickle cell disease in the emergency department.Emerg Med Pract, 2011. 13(8): p. 1-20</ref> <ref> Carden, M.A., et al., Variations in pediatric emergency medicine physician practices for intravenous fluid management in children with sickle cell disease and vaso-occlusive pain: A single institution experience.Pediatr Blood Cancer, 2018. 65(1) </ref> <ref> Carden, M.A., et al., Normal Saline Bolus Use in Pediatric Emergency Departments is Associated with Worse Pain Control in Children with Sickle Cell Anemia and Vaso-occlusive Pain.Am J Hematol, 2019. </ref>
	***There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.<ref>Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD005406. DOI: 10.1002/14651858.CD005406.pub4</ref>		***There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.<ref>Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD005406. DOI: 10.1002/14651858.CD005406.pub4</ref>
	*O2 if [[~~hypoxic~~]]; otherwise may inhibit erythropoiesis		*O2 if [[hypoxia]]; otherwise may inhibit erythropoiesis

	===Anemia===		===Anemia===

ClaireLewis: /* Management */

2019-09-24T04:03:43Z

Management

← Revisión anterior		Revisión del 04:03 24 sep 2019
Línea 32:		Línea 32:

	==Management==		==Management==
	*Analgesia		*[[Analgesia]]
	**IV [[opioids]] ([[morphine]] or [[hydromorphone]])		**IV [[opioids]] ([[morphine]] or [[hydromorphone]])
	***Redose in 30min if inadequate		***Redose in 30min if inadequate

Rossdonaldson1: /* Management */

2019-08-28T04:16:46Z

Management

← Revisión anterior		Revisión del 04:16 28 ago 2019
Línea 46:		Línea 46:
	***[[IVF]] bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling. <ref> Glassberg, J., Evidence-based management of sickle cell disease in the emergency department.Emerg Med Pract, 2011. 13(8): p. 1-20</ref> <ref> Carden, M.A., et al., Variations in pediatric emergency medicine physician practices for intravenous fluid management in children with sickle cell disease and vaso-occlusive pain: A single institution experience.Pediatr Blood Cancer, 2018. 65(1) </ref> <ref> Carden, M.A., et al., Normal Saline Bolus Use in Pediatric Emergency Departments is Associated with Worse Pain Control in Children with Sickle Cell Anemia and Vaso-occlusive Pain.Am J Hematol, 2019. </ref>		***[[IVF]] bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling. <ref> Glassberg, J., Evidence-based management of sickle cell disease in the emergency department.Emerg Med Pract, 2011. 13(8): p. 1-20</ref> <ref> Carden, M.A., et al., Variations in pediatric emergency medicine physician practices for intravenous fluid management in children with sickle cell disease and vaso-occlusive pain: A single institution experience.Pediatr Blood Cancer, 2018. 65(1) </ref> <ref> Carden, M.A., et al., Normal Saline Bolus Use in Pediatric Emergency Departments is Associated with Worse Pain Control in Children with Sickle Cell Anemia and Vaso-occlusive Pain.Am J Hematol, 2019. </ref>
	***There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.<ref>Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD005406. DOI: 10.1002/14651858.CD005406.pub4</ref>		***There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.<ref>Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD005406. DOI: 10.1002/14651858.CD005406.pub4</ref>
	#O2 if hypoxic; otherwise may inhibit erythropoiesis		*O2 if [[hypoxic]]; otherwise may inhibit erythropoiesis

	===Anemia===		===Anemia===