Acute chest syndrome (ACS) is a group of acute respiratory symptoms caused by sickle cell anemia that contains hemoglobin S. How does this syndrome occur?
Acute chest syndrome is a complication of sickle cell anemia that causes severe respiratory symptoms due to the presence of abnormal hemoglobin (S).
An overview of acute chest syndrome
Sickle cell anemia is a genetic disease that causes the formation of an abnormal hemoglobin (S), in the normal state of hemoglobin it is able to carry oxygen and infiltrate through the vessels easily, but when the red blood cells contain hemoglobin (S), its sickle shape becomes abnormal and loses its elasticity and infiltration through the vessels , And loses its ability to transport oxygen.
There are many triggers for sickle attacks, including infections, vasoconstriction and blockage, and conditions that cause hypoventilation such as asthma, chronic obstructive pulmonary disease, and other triggers of acute chest syndrome.
This syndrome causes general and respiratory symptoms, and treatment for the condition is immediate and immediate.
The disease remains with a person for his entire life and there is no treatment for it, so that prevention is done through a set of measures that prevent the occurrence of the sickness phenomenon and protect it from acute chest syndrome
The scientific name for the disease : acute chest syndrome
The common names for the disease are : acute respiratory distress syndrome
Medical classification is : hereditary diseases
Causes of acute chest syndrome
A lipid embolus or bone marrow embolism: It is one of the most common causes of vasospasm and syndrome in adults and leads to severe respiratory symptoms.
Infections: The most common causes in children, such as Chlamydia pneumonia or Mycoplasma pneumonia.
Asthma: the incidence of the syndrome is four times more common in people with sickle cell anemia than in those with sickle cell anemia without asthma.
After surgery: Vasospasm can induce pain and psychological distress or medications that the patient is taking.
Hypoxemia: during the day they have a normal oxygenation rate, but the incidence of suffocation and hypoxia at night increases.
Risk factors in the syndrome
Low levels of fetal hemoglobin.
Smoking.
Asthma or other lung disorders.
young.
Trauma or surgery.
Symptoms of acute chest syndrome
Where we see a group of severe respiratory symptoms:
fever.
Cough.
Respiratory slip.
Chest pain.
Rapid breathing.
Cicada.
When to visit the doctor
It is necessary to see a doctor if you have the disease and feel the previous symptoms or if you have any of the triggers of an attack, because treating an attack early is necessary and increases the chances of the patient’s survival.
The effect of acute chest syndrome on pregnancy
The effect on pregnancy is related to sickle cell anemia more than acute chest syndrome, and among these complications:
Vascular embolus.
Premature birth.
Spontaneous abortion.
Walid is underweight.
Urinary infections.
Diagnosis of acute chest syndrome
The diagnosis depends on a set of factors, namely:
Clinical acute respiratory symptoms.
The oxygen saturation of hemoglobin in the blood, which is 2% less than normal when breathing room air.
Partial pressure of oxygen: It is dangerous for humans when it becomes less than 60 mm Hg.
Radiographic manifestations: where we notice infiltration in the radiograph of one piece of lung at least.
Acute chest syndrome treatment
Catalytic oxygenation device
Early treatment leads to lower mortality. Once started, treatment for ACS should be offensively because the disease process can escalate rapidly.
In acute cases of acute chest syndrome, pain control includes intravenous (IV) fluids, antibiotics, oxygen, and blood transfusions.
Pain control
Pain control for children usually begins with ketorolac, so it is less likely to cause hypoventilation than opioid painkillers, and adults can also start treatment with ketorolac.
In pediatric and adult patients whose pain is not adequately controlled with ketorolac and acetaminophen, we rely on opioid painkillers.
Intravenous fluids
It is preferable to give intravenous fluids for fear of dehydration, and dehydration itself causes cases of sickness.
Therefore, it is advised to give reasonable quantities of intravenous fluids because giving intravenous fluids in additional quantities may lead to pulmonary edema and worsen respiratory symptoms.
Antibiotics
Broad-spectrum antibiotics should be given to every patient with acute chest syndrome. Also, infection is more likely in the pediatric population than in adult patients.
Patients should be started using a third-generation cephalosporin (cefotaxime or ceftriaxone) for routine bacterial coverage and of a class of macrolides (azithromycin or erythromycin). If MRSA is concerned, vancomycin should be added. The treatment should last from 7 to 10 days.
Oxygen
The stimulated oxygenator should be used every two hours in order to avoid lung atelectasis, and it is necessary to give additional oxygen to correct the decrease in SpO2 or PaO2, the SpO2 should be kept above 92%, and the PaO2 above 70 mmHg.
Transfusion
It is based on erythrocyte transfusion or transfusion:
Red blood cell transfusion has a great role in raising the level of oxygenation in the blood, and raising the value of the molecular pressure of oxygen PaO2 and the level of blood oxygen saturation with SpO2, so that it is prescribed in the event of a decrease in the hemoglobin level 10-20% or below the hematocrit curve, and in the presence of some worrisome radiographic signs In the image of the chest or delayed exchange transfusion.
The importance of red blood cell transfusion in raising the hemoglobin level to 11, or raising the hematocrit value by 30%.
As for the exchange transfusion process, it is described as acute cases, a sharp decrease in blood oxygenation levels, the appearance of pulmonary infiltrates in multiple lung lobes, or blood transfusion failure.
The aim of this operation is to raise the hemoglobin value to 10 and reduce the value of (anomalous) hemoglobin S by 30%.
Bronchodilators
It is indicated that bronchodilators are approved in the event of underlying asthma. However, it can be given in any situation where bronchospasm is identified or suspected.
Complications of acute chest syndrome
Since acute respiratory syndrome can cause a dangerous lack of oxygen to important parts of the body such as the lungs, brain, ears, kidneys, and other vital organs, it can potentially cause significant damage or become fatal. Damage to these organs can lead to permanent problems with speaking, walking, learning, and other daily functions.
It also causes a host of risks such as: lung failure, pulmonary infarction, and chronic obstructive pulmonary disease.
Prevention of acute chest syndrome
This is done through a few steps:
Hydroxyurea is a drug that increases fetal hemoglobin, as studies have shown that it reduces respiratory attacks by 50% in adults and 30% in children.
However, it should be noted that this drug is not prescribed to all patients, only those who suffer permanently from acute attacks.
It is advised to give influenza vaccines and pneumonia vaccines to prevent the occurrence of lung infections that cause sickness and acute chest attack.
The stimulated oxygenation device is recommended when starting to feel tight, as it protects the lung from atelectasis and saves the patient from an attack.
Of course, if symptoms occur, hurry to the nearest medical center, because the sooner the treatment is given, the better the chances of life and the better the survival rate.
Not to take any medication before making sure of its side effects and consulting a doctor, as it may cause narrowing of the arteries and the emergence of sickle cell attacks.
Celebrities afflicted with acute chest syndrome
Mills Davis
Layers Tat
Common questions about acute chest syndrome
Why do not get sickness attacks in the fetus?
Because fetal hemoglobin type HbF and sickle cell anemia affect normal human hemoglobin (HbA).
What are the side effects of hydroxyurea?
diarrhea.
Nausea
Vomiting
Anorexia.
Hair loss.
Confusion.
Infections in the mouth and pharynx.
rash.
It should be noted that the side effects, if they last for a long time or do not decrease with the passage of time, should be referred to the doctor.
Acute chest syndrome can be avoided by a person with some recommendations, and if an attack occurs, see the medical center as soon as possible.
