1. A 17-year-old female patient presented with complaints of body and limb ache, back pain, fatigue, and generalized weakness. Laboratory tests confirmed she had sickle cell anemia based on low hemoglobin and red blood cell counts and an elevated reticulocyte count. 2. She was treated with injections of tramadol, ranitidine, and ondansetron for pain and nausea along with intravenous fluids, hydroxyurea capsules, and folic acid tablets. 3. Her symptoms improved and laboratory values normalized before discharge with a treatment plan of continued hydroxyurea, folic acid, and pantoprazole tablets to prevent future sickle cell crises and complications.

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CASE PRESENTATION ON
SICKLE CELL ANEMIA
PRESENTED BY- SHIVAMKUMAR A. AGRAWAL
B.PHARM 4TH YEAR
ENROLL NO: 200823101023

2. • INTRODUCTION:
 SICKLE CELLANEMIA (SCA): Sickle cell anemia is A serious disease
in which the body makes sickle-shaped (“c”-shaped) red blood cells. Normal
red blood cells are disk-shaped and move easily through your blood vessels.
Red blood cells contain the protein hemoglobin.
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3.  Sickle cells contain abnormal hemoglobin that causes the cells to have a sickle
shape, which don’t move easily through the blood vessels – they are stiff and
sticky and tend to form clumps and get stuck in the blood vessels.
The clumps of sickle cells block blood flow in the blood vessels that lead to the
limbs and organs. Blocked blood vessels can cause pain, serious infections and
organ damage.
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4. • PATHOPHYSIOLOGY OF SCA: 4

5. • SUBJECTIVE EVIDENCE
AGE 17 YEARS
SEX FEMALE
UNIT FEMALE MEDICINE WARD
IP NUMBER 18022502
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6. COMPLAINTS ON ADMISSION:
 C/O - Body & Limb Ache,
- Back Pain & Fatigue,
- Generalized Weakness
PAST MEDICAL HISTORY:
 SICKLE CELL ANEMIA SINCE 3 YEARS
PAST MEDICATION HISTORY:
 Blood Transfusion 4-5 times
FAMILY AND SOCIAL HISTORY:
 NAD.
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7. • OBJECTIVES:
PHYSICAL EXAMINATION:
 BP: 130/80mmhg
 Pulse: 86/min
 Temperature: 96˚F
 Spo2- 97%
 CVS – S1, S2 heard
 CNS – conscious and oriented
 PA – soft, non tender
 RS- AEBE clear
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8. • OBJECTIVES:
PHYSICAL EXAMINATION:
 Appetite – Decreased
 Sleep – Abnormal
 Pallor – Slightly Positive
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9. • LABORATORY INVESTIGATION
LAB PARAMETERS 14/08/2018 17/08/2018 NORMAL VALUE UNIT
Hb 9.3 11.9 11.5 – 18 g/dl
RBC 3.5 4.7 3.8-5.8 million/mm3
WBC 11000 11000 4000 – 11000 cells/ cmm
Neutrophils 84 68 40 – 70 %
Lymphocytes 12 32 20 – 40 %
Monocytes 03 07 2 – 10 %
Eosinophils 01 05 1 – 6 %
ESR 28 14 1 – 20 mm/hr
Platelets 4.44*10^5 3.5 * 10^5 (1.5 – 4.0) * 10^5
RDW-CV 18.8 12.3 11-14.6 %
MCH 18.7 30 27 – 31 pg
MCHC 29.1 32 32 – 36 g/dl
MCV 64.1 92 78 – 100 fL
PCV 28.5 52 40- 54 %
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10.  Specific Diagnostic Tests:
(14/08/18)
 Sickling Test : Positive
 USG (Spleen) : Indicate Mild Splenomegaly
 Malarial Parasite Test : Negative
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11. • ASSESSMENT
 A 17 year female patient was admitted to female med.Unit-2, had complains
of Generalized weakness, back pain & fatigue & body pain since 3 days.
 Based on lab reports patient’s Hemoglobin, Lymphocytes, RBCs, PCV,
MCV, MCH, MCHC were Decreased & Neutrophils, ESR, RDW-CV level
was also Increased. Hence, based on the Subjective, objective & Positive
Sickling Test evidences show the patient was confirmed with diagnosis of
SICKLE CELLANEMIA.
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12. • FINAL DIAGNOSIS
SICKLE CELLANEMIA
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13. • GOALS OF TREATMENT
 To Induce Complete Remission.
 To control or reduce the frequency and severity of Body Pain.
 Minimize side effects.
 Improve Quality Of Life.
 To reduce the frequency of vaso-occlusive crises.
 Prevent organ damage.
 To maintain Hb and RBC levels.
 To make patient understand the importance of medication
adherence.
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14. PLANNING
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15.  CURRENT TREATMENT: 15
Generic Name Indication Route Dose Frequency Day-1 Day-2 Day-3 Day-4 Day-5
Inj. Tramadol Analgesics IV 50mg Stat ✔ ✔ ✔ ✔ ✔
Inj. Ranitidine Antacid IV 50mg QID ✔ ✔ ✔ ✔ ✔
Inj. Ondansetron Anti-Emetic IV 4mg QID ✔ ✔ ✔ ✔
Inj. DNS IV fluid & Electrolytes
Nutrients
IV 100ml Stat ✔ ✔ ✔ ✔ ✔
Cap. Hydroxy Urea Anti-Sickling PO 500mg OD ✔ ✔ ✔
Tab. Folic Acid Folic Acid Deficieny PO 5mg OD ✔ ✔ ✔

16. 1. Inj. Tramadol
 Class Of Drug: Opiate (narcotic) Analgesics
 Dose: 50mg
 MOA: Tramadol inhibits serotonin reuptake and tramadol inhibits
norepinephrine reuptake, enhancing inhibitory effects on pain transmission in the
spinal cord.
 Indications: Acute Pain Premature Ejaculation •Severe Pain, Acute,
moderate, severe Pain, Moderate Pain.
 Side Effects: Headaches, Feeling sleepy, tired, dizzy, Feeling or being sick
(nausea or vomiting) Constipation, Dry mouth, Sweating, Low energy.
 ADRs: feel dizzy, tired and have low energy.
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17. 2. Inj. Ranitidine
 Class Of Drug: H2 blockers
 Dose: 50mg
 MOA: Ranitidine is a competitive inhibitor of histamine H2-receptors
 Indications: indigestion, heartburn and acid reflux, gastro-oesophageal reflux
disease (GORD) Duodenal ulcer disease, Hyper secretory conditions.
 Side Effects: Clay- colored stools, Coughing up mucus, Dark urine, Irregular
heartbeat, Loss of appetite, red skin rash with headache, Vision problems.
 ADRs: dizziness, insomnia, vertigo, mental confusion, agitation, and
hallucinations, Tachycardia, bradycardia.
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18. 3. Inj. Ondansetron
 Class Of Drug: Serotonin 5-HT3 receptor antagonists
 Dose: 4mg
 MOA: It works by blocking the action of a chemical messenger (serotonin) in
the brain
 Indications: Nausea and vomiting caused by cancer chemotherapy, radiation
therapy, and surgery.
 Side Effects: Headache, Constipation, Weakness, Tiredness, Chills, drowsiness
 ADRs: Chest pain, slow/fast/irregular heartbeat, severe dizziness, fainting.
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19. 4.Cap. Hydroxy Urea
 Class Of Drug: Antimetabolites
 Dose: 500mg
 MOA: It works by increasing fetal haemoglobin (HbF) levels in red blood cells
(RBCs)
 Indications: Resistant chronic myeloid leukemia
 Side Effects: Blood in the urine. yellowing of the skin or eyes. numbness,
burning, or tingling in the hands or feet. fever, cough, shortness of breath, and
other breathing problems
 ADRs: Allergic reactions like skin rash, itching, swelling of the face, lips, or
tongue, breathing problems, burning.
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20. 5. Tab. Folic Acid
 Class Of Drug: B-complex vitamin
 Dose: 5mg
 MOA: Folic acid is synthesized by bacteria from the substrate, para-amino-
benzoic acid (PABA), and all cells require folic acid for growth.
 Indications: Preventing and treating low blood levels of folate (folate
deficiency) and high blood levels of homocysteine (hyperhomocysteinemia)
 Side Effects: Feeling sick (nausea), Loss of appetite, Bloating or wind.
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21.  DISCHARGE MEDICATION
Drug Name Route Dose Frequency Duration
Cap. Hydroxy Urea PO 500mg OD 15 Days
Tab. Folic Acid PO 5mg OD 15 Days
Tab. Pantoprazole PO 40mg BD 15 Days
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22.  GOALS ACHIEVED
 Patient Felt Symptomatically Better On The Day Of Discharge.
 All Laboratory Parameters Are Normalised.
 No Any Symptoms Or Complication Are Seen On Discharge Day.
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23. • DRUG INTERACTIONS
 No Any Drug-Drug Interactions were Found.
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24. • Medication Error / Pharmacist Interventions:
 No Any Medication Error & Pharmacist Interventions were Found.
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25.  PATIENT COUNSELLING:
COUNSELLING REGARDING DISEASE
 SICKLE CELLANEMIA (SCA): A group of disorders that cause red
blood cells to become misshapen and break down.
 With sickle cell disease, an inherited group of disorders, red blood cells contort
into a sickle shape. The cells die early, leaving a shortage of healthy red blood
cells (sickle cell anaemia) and can block blood flow causing pain (sickle cell
crisis).
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26. • PATIENT COUNSELLING
COUNSELLING REGARDING MEDICATION.
1. Cap. Hydroxy Urea: Hydroxy Urea Capsule is an anti-sickling medicine used to treat fetal
haemoglobin (HbF) levels in red blood cells (RBCs) in Sickle cell Anaemia.
 Take Daily At 30 Minutes After Meal & Take same time everyday.
2. Tab. Folic Acid: Take Daily At 30 Minutes After Meal.
 Folic Acid Tablet is used to treat and prevent Low blood levels in Sickle cell Anaemia.
 Swallow the tablet whole with a drink of water.
3. Tab. Pantoprazole: Pantoprazole Tablet is used to Treat & Inhibit Gastric Acid secretion in Stomach.
 Take Daily At 30 to 60 Minutes Before Meal.
 Take the first dose before breakfast & the second dose before dinner.
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27.  PATIENT COUNSELLING:
Counselling Regarding Life Style Modifications:
 Drink 8 to 10 glasses of water every day and eat healthy food.
 Eat a balanced diet, including folic acid supplementation
 Drink plenty of water
 Avoid excessive exercise
 Get sufficient rest
 Rest in bed during acute sickle cell crisis
 Avoid emotional and physical stress
 Fruits such as pomegranates increase blood flow and bananas boost energy levels.
Increased blood flow reduces the chances of acute crisis and more energy helps to
combat fatigue.
 Avoid factors that can worsen your condition or lead to infection
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