QLexNursing

Acute Chest Syndrome

💎Acute chest syndrome is one of the most serious complications of sickle cell disease and is a leading cause of hospitalization and mortality in these clients. It is defined by the triad of new pulmonary infiltrate on chest imaging, respiratory symptoms, and fever in a patient with sickle cell disease.

💎In this case, the client’s progression from mild pain and slight wheezing to severe chest pain (9/10), shortness of breath, tachypnea (RR 32/min), hypoxemia (SaO₂ 90%), and productive cough with pink-tinged sputum are hallmark signs of ACS.

💎The mechanism involves sickled red blood cells occluding pulmonary vasculature, leading to ischemia, inflammation, and pulmonary infarction, which worsens hypoxemia and promotes further sickling — creating a dangerous cycle.

💎ACS often develops after infection, surgery, or dehydration, and it requires urgent interventions: supplemental oxygen, broad-spectrum antibiotics, aggressive pain management, IV fluids, and sometimes exchange transfusion to reduce the proportion of sickled cells.

💎Prompt recognition is critical because untreated ACS can rapidly progress to respiratory failure, pulmonary hypertension, and death.

Pneumonia

💎Pneumonia is a common precipitating factor of ACS, especially in sickle cell patients who are immunocompromised due to functional asplenia (loss of splenic function from repeated infarctions). This predisposes them to encapsulated bacterial infections (e.g., Streptococcus pneumoniae, Haemophilus influenzae).

💎The client’s fever (38.7°C), cough producing pink-tinged mucus, localized wheezing in the left lung, and tachycardia are strongly suggestive of a pulmonary infection.

💎Pneumonia increases pulmonary inflammation and consolidation, which further impairs gas exchange and accelerates the sickling process in the pulmonary circulation, thereby worsening ACS.

💎Management includes broad-spectrum IV antibiotics to cover likely pathogens, in addition to supportive care. Early antibiotic therapy reduces morbidity and mortality significantly in sickle cell patients with ACS.

💎Recognizing pneumonia as an underlying cause of ACS helps guide targeted therapy, as addressing both conditions concurrently is essential to prevent progressive respiratory compromise.