Sickle cell disease is a genetic haemoglobin disorder affecting millions of people worldwide. Pain is one of the most commonly reported complication of sickle cell disease. Pain is further classified into two categories acute pain and chronic pain. Chronic pain is associated with more serious complications. Management of pain has a significant impact on quality of life of sickle cell disease patients. The purpose of this research is to review the available information about acute and chronic pain management in sickle cell disease. The best treatment for both acute and chronic pain requires a customized, varied approach. This approach combines therapeutic, non-pharmacological therapies, as well as integrated therapies as per the specific needs of each patient. Opioids are effectively used in management of the pain of sickle cell disease and their use is supported by literature especially in chronic pain. Methadone, ketamine, and nitrous oxide are also used to manage pain. For the treatment of acute pain, nonsteroidal anti-inflammatory medications, short-acting opioids, and adjuvants are used effectively in clinical practice. Opioids have become the recommended treatment for pain in sickle cell disease, and many chronic pain patients are sustained on opioid therapy for the rest of their lives. However, the distinction between acute and chronic opioid therapy modalities is blurred in sickle cell disease due to the association between recurring acute pain and chronic pain. Limited literature is available regarding management guidelines and therapeutic strategies so more clinical research and trials are needed in future to design and study effective management strategies for both acute and chronic pain.
Blood transfusion is a common procedure in the realm of medicine and surgery to treat hematological disorders such as iron and hemoglobin deficiency, during and after major surgical or invasive procedures, and in the event of trauma. However, this life saving procedure does not come without adverse complications and risks. In this review we will extensively discuss the indications of blood transfusion and the complications associated with blood transfusion. An extensive literature search was conducted in online databases such as PubMed, Google Scholar to include various publications such as narrative reviews, editorials and clinical practice guidelines on the indications of blood transfusion and its associated complications. After numerous large scale clinical trials and studies, the transfusion trigger for hemoglobin has been readjusted to a lower threshold thus preventing excessive transfusions and thereby limiting complications. There are a wide range of complications and adverse events associated with blood transfusions. Non-infectious transfusion reactions can contribute to significant morbidity and mortality and occur more commonly as compared to infectious transfusion reactions. Non-infectious reactions can be immune mediated and non-immune mediated and can also be subdivided based on their timing and occurrence after transfusion as acute occurring within 24 hours of transfusion and delayed as occurring 24 hours after transfusion. Further studies are warranted to create more precision on indications of blood transfusion especially for blood components such as platelets, fresh frozen plasma and cryoprecipitate are still undefined and need further trials to set cut-off limits to indicate transfusion.
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