- Acute Multiorgan Failure – Defined as the acute deterioration in function of two of three
organ systems: the lung, liver, and kidney. There is often also deterioration in mental status and
evidence of rhabdomyolysis. A fall in hemoglobin and platelet count form baseline are early
manifestations.
- Acute Chest Syndrome - defined as a new chest infiltrate in a sickle cell patient-
Etiologies include pneumonia, pulmonary infarction, bone pain from sickling, bone infarction,
and fat embolism.. Differentiation of these disorders can be very difficult and all occur in high
frequency in patients with sickle syndromes. Fat embolism, pneumonia, and pulmonary
infarction cause pleuritic chest pain, fever, leukocytosis, pulmonary infiltrates, hemoptysis, and hypoxia. Pulmonary infarctions occur de novo without emboli from phlebitis. Pneumonia is more
likely in children, with high fever, leukocytosis with left shift. Older children and adults have
purulent sputum (younger children swallow theirs). Chest radiograph often reveals a small
pleural effusion. Infarction from sickling is more common in adults, with hemoptysis, positive
V/Q scan with negative chest x-ray, and in patients without fever or leukocytosis. If in doubt,
always treat for pneumonia. Liver tests and creatinine remain normal.
- Drug Overdose - Because of the severity of the pain, the patients are often receiving high
doses of narcotics so initial change in mental status may be attributed to overdose of
medications. Change in the laboratory parameters notes above and failure to respond to narcan
administration support the diagnosis of multiorgan failure.