Advanced International Journal for Research

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Sickle Cell Disease Revisited: Mechanisms, Literature Integration, and a Protocol for Crisis Care: an Integrative Review

Author(s) Ms. NICOLE WAFULA, Prof. Dr. NICHOLAS ABINYA
Country Kenya
Abstract BACKGROUND
The most common cause of admission of sickle cell patients is Vaso-occlusive crisis which is the obstruction of vessels in the microcirculation by sickled cells. It is known that sickling of red blood cells happens when the patient is dehydrated and then they are exposed to hypoxic state. Despite this being a common clinical presentation of sickle cell patients, it has been noted that ta standard or a more evidence-based guideline on how to manage these patients to be an area that is still evolving and significant gaps persist making it inadequately defined with several aspects yet to be fully explored.

METHODOLOGY
This study is an integrative review that aims at explaining sickle cell disease from the basic intricate details to the pharmacological management of these patients. Therefore, there is a systemic review aspect which involves summarization of current published data explaining the pathophysiology of Vaso-occlusion, efficacy of intravenous fluid for hydration, pain management and toxins produced during ischemia as a result of VOC. A database search of PubMed, Wiley Cochrane, Scopus were performed. Of 5381 identified papers using the key search words a total of 28 studies which were a mixture of laboratory trials report, original research and systemic reviews were found eligible for the study. This research also involves original new data which consists of input from physicians obtained through a google form which aims at understanding their go to method of managing sickle cell patients, average stay of sickle cell patients in hospitals and what challenges they experience while managing sickle cell patients in a crisis.

EXPECTED OUTCOMES AND SIGNIFICANCE
We anticipate to explain the mechanism behind Vaso-occlusive crisis and how pharmacologic management from the intravenous fluid administration and pain killers use can be guided by the mechanisms behind the VOC. We also anticipate to clarify why some of the currently used methods might be detrimental especially in management of sickle cell patients.
PROTOCOL
This research also involves the introduction of basic protocol schematic that can help guide physicians when dealing with sickle cell patients while drawing reference from a paper written by John Hopkins All Children’s Hospital guideline but using conditions that are mostly seen in Kenya.
CONCLUSION
In conclusion, some of the currently used management strategies of VOC are dangerous such as use of 0.9% normal saline in IV fluid hydration which has been proved to even worsen the cell sickling while an alternative is being proposed more likely a fluid with an osmolarity of (111-122) mEq/L. The promising use of intravenous acetaminophen rather than NSAIDS might be more useful in managing the pain.
Keywords sickle cell and vaso-occlusion, sickle cell and intravenous fluid
Field Medical / Pharmacy
Published In Volume 6, Issue 5, September-October 2025
Published On 2025-10-13
DOI https://doi.org/10.63363/aijfr.2025.v06i05.1579
Short DOI https://doi.org/g97nw6
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