Virtual Conference
Cardiology Conference 2023

Christian Kassasseya

Henri Hospital, Mondor/ Hospitals of Paris, France

Title: Management of a patient with sickle cell disease in an emergency room


Sickle cell disease is today the first genetic disease in France with approximately 30,000 adult patients. A point mutation on chromosome 11 leads to the production of pathological hemoglobin which polymerizes under the effect of endogenous or exogenous factors inducing the sickling of red blood cells causing arterial vaso-occlusion, one of the consequences of which is the obliteration of vessels destined for bone. Bone infarcts are particularly painful, leading patients to emergencies where the challenge is to quickly and effectively relieve pain by using morphine mainly by self-controlled analgesia after morphine titration. The major risk during these Vaso-Occlusive Crises (VOCs) is the appearance of an acute thoracic syndrome (ATS) which can be lifethreatening for the patient. Incentive spirometry is an important preventive means of ATS to be instituted in emergencies. Antibiotic therapy will be implemented in the event of fever in these asplenic patients at risk of infections with encapsulated germs, in particular pneumococcus. Transfusion exchange is one of the cornerstones of the treatment of VOC or ATS, but the risk of acute hemolytic accident post transfusion must limit its use to situations involving the vital or functional prognosis of an organ. Several clinico-biological scores make it possible to decide on the usefulness of a thoracic computed tomography (CT) angiography during the ATS in search of a pulmonary embolism or to decide on the relevance of discharge to home hospitalization (DREPADOM program). Prolonged use of morphine outside the hospital should be cautious because of the risk of addiction.


Christian Kassasseya is an emergency physician at Henri Mondor Hospital (Créteil, France), a reference center for sickle cell disease. More than 3,000 sickle cell patients are followed at this university hospital, where the emergency department registers 1,500 visits for vaso-occlusive crises each year. He has completed his training as an emergency physician by specializing in sickle cell disease with several degrees and is currently preparing a PhD on the subject.