Hemoglobin

Osteomyelitis in Sickle Cell Anemia

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Osteomyelitis in Sickle Cell Anemia, Osteomyelitis in Thalassemia, Osteomyelitis in Hemoglobinopathy

  • See Also
  1. Osteomyelitis
  2. Sickle Cell Anemia
  3. Transient Red Cell Aplasia
  4. Acute Chest Syndrome
  5. Acute Vaso-Occlusive Episode in Sickle Cell Anemia
  6. Aplastic Crisis in Sickle Cell Anemia
  7. Cerebrovascular Accident in Sickle Cell Anemia
  8. Dactylitis in Sickle Cell Anemia (Hand Foot Syndrome in Sickle Cell Anemia)
  9. Hematuria in Sickle Cell Anemia
  10. Priapism in Sickle Cell Anemia
  11. Pulmonary Hypertension in Sickle Cell Anemia
  12. Septic Arthritis in Sickle Cell Anemia
  13. Sickle Cell Anemia Related Pulmonary Hypertension
  14. Sickle Cell Anemia with Splenic Sequestration
  • Pathophysiology
  1. Infection of infarcted bone
  2. Most common Osteomyelitis sites (due to highly vascular Bone Marrow)
    1. Long bones (multiple sites in same bone may be involved)
    2. Spine
    3. Sternum
  • Causes
  1. Bone infarction
    1. Bone infarction is far more common than Osteomyelitis
  2. Infections
    1. See See Osteomyelitis
    2. Staphylococcal Aureus (<25% of cases)
    3. Salmonella
      1. SCA patients are susceptible to this encapsulated organism due to Asplenia
      2. Most common organism in Sickle Cell AnemiaOsteomyelitis
      3. Other Gram Negative Bacteria may also occur
  • Signs
  1. Fever
    1. Fever duration directly correlates with likelihood of Osteomyelitis (risk increases 80% each day of fever)
  2. Extremity swelling
    1. Osteomyelitis likelihood increases 8.4 fold
  3. Bone pain
    1. Osteomyelitis likelihood increases 20% each day of pain
  • Diagnosis
  1. Bone Culture
  • Labs
  1. Blood Cultures
    1. Test Sensitivity: 30 to 76%
  • Imaging
  1. See Osteomyelitis
  2. Interpretation may be difficult in Sickle Cell Anemia as bone infarcts may appear similar to Osteomyelitis
  • Management
  1. See Osteomyelitis
  2. Bone infarctions are typically self limited (in contrast, of course, to Osteomyelitis)
  3. Antibiotics are similar to those used in other Osteomyelitis with added Salmonella and Gram Negative coverage
    1. Total Antibiotic course: 6 to 8 weeks
    2. Initial IV: Vancomycin AND (Ciprofloxacin or Ceftriaxone)
    3. Later: May transition to Oral fluoroquinonoles (Ciprofloxacin, Levofloxacin) for susceptible Gram Negative causes
  • References
  1. Dwyer, Kleinmann, Goswami and Lopez (2025) Crit Dec Emerg Med 39(1): 26-35
  2. Lowe and Wang (2018) Crit Dec Emerg Med 32(11): 17-25
  3. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23