Aplastic crisis

Background

• Also called Reticulocytopenia: abnormal decrease of reticulocytes in the body
• Clinically common in Sickle cell crisis and Hereditary Spherocytosis (HS)

Clinical Features

• Sickle cell crisis
• Anemia
• Increased fatigue, pallor
• Activity intolerance
• Shortness of breath

Causes

• Erythema Infectiosum (Fifth disease)
  • Invades and destroys red blood cell precursors and halts the red cell production
• EBV
• Strep infection
• Use of hydroxyurea

Labs

• CBC with retic count
  • Decrease from baseline hemoglobin/hematocrit
  • Precipitous drop in reticulocyte count (or lack of response)

Management

• Admit
• Transfusion using extended antigen-typed, leuko-depleted pRBCs
• Droplet precautions

Recovery Phase

• Typically in 1-2 weeks
• Often marked by hyperbilirubinemia, and called a “hyperhemolytic” phase

Also See

• Erythema Infectiosum (Fifth disease)
• Hereditary Spherocytosis (HS)
• Sickle cell crisis

References

• Janz TJ, Hamilton GC: Anemia, Polycythemia, and White Blood Cell Disorders, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 7. St. Louis, Mosby, Inc., 2010, (Ch) 119:p 1568-1574.
• http://www.ihtc.org/medical-professionals/blood-disorders/sickle-cell-disease/aplastic-crisis-intervention/ - last accessed 1/6/15