Sickle cell crisis (also known as vaso-occlusive crisis) is characterized by pain in the hands and feet (especially in children), bones, chest, abdomen, back, and joints. It can also involve fever, shortness of breath, weakness of the body, severe headache, nausea, and vomiting, etc. The symptoms can last for several hours to days and should be treated immediately they occur.
Certain things are known to trigger a sickle cell crisis. However, sometimes when it occurs, one may not be very sure of what caused it. But it’s important for sickle cell patients, their friends and caregivers to be aware of the potential triggers of a crisis and avoid them as much as possible.
In simple terms, a sickle cell crisis occurs when the amount of oxygen in the blood is reduced. This causes the red blood cells to assume a sickle shape and increases the tendency of red blood cells to stick to the surface of blood vessels and block the free flow of blood to organs. This reduces oxygen supply to the organs (ischemia) leading to pain and other symptoms.
The triggers of sickle cell crisis: what sickle cell patients should avoid
The following are known to trigger a sickle cell crisis. Therefore, avoiding them will reduce the frequency of crisis and improve patient quality of life.
One thing is common among these triggers — they either reduce the amount of oxygen in the blood or they increase the body’s demand for oxygen.
1. Environmental conditions of low oxygen
These include poor ventilation in the room, overcrowding, and places of high altitude.
Dehydration can be caused by diarrhea and vomiting. Dehydration increases the body’s acidity. An increase in the body’s acidity is biologically known to reduce the ability of hemoglobin to accept and carry oxygen. Hemoglobin is the oxygen-carrying pigment in the blood. Technically speaking, an increase in the body’s acidity caused by dehydration, shifts the oxy-hemoglobin dissociation curve to the right. (LOL, time for a bit of revision for clinical students reading this).
3. Extremes of temperature
Cold and hot weathers are also triggers of sickle cell crisis. High temperature is known to reduce the affinity of hemoglobin for oxygen, just like what dehydration does.
4. Strenuous exercise
Exercise is good for everyone including sickle cell patients. But strenuous exercise can trigger sickle cell crisis because it can quickly use up the oxygen in their blood and increase the demand for more oxygen. This can unsettle the individuals and precipitate a crisis.
Prolonged stress can trigger crisis same way as strenuous exercise.
Smoking can damage the lungs and decrease the ability to breathe well. Therefore, sickle cell patients must not smoke. Those who do should immediately seek help to stop smoking.
Alcohol consumption is not safe for these patients. It could trigger a crisis though to a lesser extent than smoking.
Infections, especially those caused by Streptococcus pneumoniae and Hemophilus influenzae, can trigger sickle cell crisis. Sickle cell patients are immunocompromised. Infections can further reduce the body’s immunity, stimulate diarrhea and vomiting leading to dehydration. Regular hand washing and taking pneumococcal, meningococcal, and haemophilus influenzae vaccines will help to reduce the frequency of infections.
What to do when sickle cell crisis occurs
- Drink enough water to stay hydrated.
- Take an over-the-counter pain medicine that has been recommended by your doctor.
- Wear warm clothing if the weather is cold.
- Ensure that the room is well aerated and avoid overcrowded places.
- Seek immediate medical attention if the symptoms do not resolve.
As the old saying goes, prevention is always better than cure. In addition to avoiding the 8 triggers I’ve mentioned, medications such as hydroxyurea and L-glutamine oral powder can help to reduce the frequency and severity of sickle cell crisis. But these medicines must only be taken when prescribed by your doctor.